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Medical Management - Supervisor Medical Review 145-4005 at CommunityCare
Tulsa, Oklahoma, United States - Full Time
Skills Needed
Analytical Skills, Problem Solving, Decision Making, Attention To Detail, Organizational Skills, Microsoft Applications, Oral Communication, Written Communication, Teamwork, Supervision, Training, Coaching, Auditing, Performance Evaluation, Healthcare Coding, Regulatory Knowledge
Specialization
Candidates must have an active RN license in Oklahoma and a minimum of five years of experience in healthcare settings or managed care organizations. Supervisory experience and familiarity with healthcare regulations and coding are preferred.
Experience Required
Minimum 5 year(s)
Business Development Director at Onsite Wellness Group LLC
Cumberland Furnace, Tennessee, United States - Full Time
Skills Needed
Business Development, Relationship Management, Market Research, Strategic Planning, Coaching, Training, Collaboration, Customer Service, Networking, Therapeutic Processes, Healthcare Compliance, Event Planning, Sales, Leadership, Accreditation, Communication
Specialization
The position requires extensive knowledge of Onsite’s services and the ability to communicate effectively. Candidates should have experience in business development and a comprehensive understanding of healthcare regulations.
Experience Required
Minimum 5 year(s)
Business Development Director at Al Moosa Career Portal
Al Ahsa Governorate, Eastern Province, Saudi Arabia - Full Time
Skills Needed
N/A
Specialization
Candidates should have a strong background in business development and proven experience in leadership roles. Excellent communication and negotiation skills are essential.
Experience Required
Minimum 5 year(s)
Business Development Director at Qureos Inc
Riyadh, Riyadh Region, Saudi Arabia - Full Time
Skills Needed
Business Development, Sales Leadership, Experiential Marketing, Immersive Installations, Exhibitions, Entertainment Venues, Events Production, Cultural Institutions, Strategic Thinking, Consultative Selling, Crm Proficiency, Relationship Building, Market Intelligence, Team Building, Communication Skills, Cultural Intelligence
Specialization
Candidates must have over 8 years of experience in business development or sales leadership in Saudi Arabia, with a proven track record of closing high-value deals. An established network in the KSA entertainment and tourism sectors, along with exceptional communication skills in Arabic and English, is essential.
Experience Required
Minimum 10 year(s)
Assistant Fitness Manager at EōS Fitness
Santa Barbara, California, United States - Full Time
Skills Needed
Leadership, Interpersonal Skills, Sales, Customer Service, Communication, Relationship Building, Detail Orientation, Problem Solving, Time Management, Organizational Skills, Record Keeping, Fitness Knowledge, Team Management, Training, Motivation, Fitness Certifications
Specialization
Candidates should have 2 years of management experience and 2-3 years of customer service experience. A valid Personal Training certification and CPR certification within 30 days of hire are also required.
Experience Required
Minimum 2 year(s)
ALTERATIONS ASSOCIATE at Von Maur/Dry Goods
Livonia, Michigan, United States - Full Time
Skills Needed
Customer Experience, Garment Alterations, Sewing, Measuring, Fitting, Repairing, Cleaning, Ironing, Steaming, Attention To Detail, Communication, Teamwork, Problem Solving, Time Management, Customer Service, Basic Sewing Techniques, Advanced Alterations
Specialization
Candidates must be professionally competent in all basic and most advanced alterations. The role requires a friendly demeanor and the ability to maintain a clean work area.
ALTERATIONS ASSOCIATE at Von Maur/Dry Goods
Rochester Hills, Michigan, United States - Full Time
Skills Needed
Customer Experience, Garment Alterations, Sewing, Measurement, Fitting, Repair, Ironing, Steaming, Attention To Detail, Cleanliness, Basic Sewing, Moderate Sewing, Tailoring, Formal Wear, Friendly Communication, Customer Service
Specialization
Candidates must be professionally competent in all basic and most advanced alterations. Experience with diverse styles of women's garments is essential.
Operations Manager at Apparel Group
, , Saudi Arabia - Full Time
Skills Needed
Sales Management, Customer Service, Team Leadership, Training And Development, Inventory Management, Visual Merchandising, Operational Efficiency, Performance Evaluation, Cost Management, Recruitment, Communication, Succession Planning, Loss Prevention, Project Management, Brand Management, Market Awareness
Specialization
The role requires strong experience in sales management and operational oversight, with a focus on employee development and performance evaluation. Candidates should have a proven track record in retail management and effective communication skills.
Experience Required
Minimum 5 year(s)
Orthodontist - Part Time at DOCS Health
Columbia, South Carolina, United States - Full Time
Skills Needed
Organizational Skills, Patient Care, Communication Skills, Interpersonal Skills, Diagnostic Procedures, Treatment Planning, Appliance Adjustment, Education Skills, Professionalism, Positive Attitude, Calm Approach, Fairness, Consistency, X Ray Utilization, Dental Instruments, Relationship Building
Specialization
Candidates must have a DDS or DMD from an accredited US program with an Orthodontics Specialty and an active South Carolina Dental License. Strong communication and interpersonal skills, along with proficiency in Microsoft Suite, are also required.
Experience Required
Minimum 2 year(s)
Orthodontist - Part Time at DOCS Health
Town of Le Ray, New York, United States - Full Time
Skills Needed
Orthodontics, Patient Care, Communication Skills, Organizational Skills, Microsoft Suite, Diagnostic Tools, Treatment Planning, Interpersonal Skills, Workflow Management, Relationship Building, X Rays, Fixed Appliances, Removable Appliances, Aligners, Adjustments, Education
Specialization
Candidates must have a DDS or DMD from an accredited program with an Orthodontics Specialty and an active, unrestricted State Dental License. Proficiency in essential orthodontic procedures and strong interpersonal skills are also required.
Experience Required
Minimum 2 year(s)
Orthodontist - Part Time at DOCS Health
, North Carolina, United States - Full Time
Skills Needed
Orthodontics, Patient Care, X Rays, Diagnostic Tools, Fixed Appliances, Removable Appliances, Aligners, Patient Education, Organizational Skills, Microsoft Suite, Workflow Management, Relationship Building, Clinical Autonomy, Background Check, Drug Screening, Vaccinations
Specialization
Candidates must have a DDS or DMD from an accredited program with an Orthodontics Specialty and an active, unrestricted State Dental License. Proficiency in essential orthodontic procedures and strong organizational skills are also required.
Experience Required
Minimum 2 year(s)
Endodontist - Part Time at DOCS Health
Fort Stewart, Georgia, United States - Full Time
Skills Needed
Endodontics, Root Canal Therapy, Pulpotomies, Apicoectomies, Digital Radiography, Patient Education, Clinical Documentation, Infection Control, Collaboration, Treatment Planning
Specialization
Candidates must have a DDS or DMD from an accredited dental program and completion of an accredited Endodontics residency program. An active, unrestricted state dental license and CPR/BLS certification are also required.
Experience Required
Minimum 2 year(s)
Orthodontist - Part Time at DOCS Health
, Puerto Rico, United States - Full Time
Skills Needed
Orthodontics, Patient Care, X Rays, Diagnostic Tools, Fixed Appliances, Removable Appliances, Aligners, Patient Education, Organizational Skills, Microsoft Suite
Specialization
Candidates must have a DDS or DMD from an accredited program with an Orthodontics Specialty and an active, unrestricted State Dental License. Proficiency in essential orthodontic procedures is required.
Experience Required
Minimum 2 year(s)
Hygienist - Part Time at DOCS Health
Calcium, New York, United States - Full Time
Skills Needed
Dental Hygiene, Patient Education, X Ray Certification, Cpr Certification, Gingivitis Assessment, Periodontitis Assessment, Fluoride Application, Treatment Planning, Patient Communication, Record Keeping, Team Collaboration, Hipaa Knowledge, Denticon Knowledge
Specialization
Candidates must have an active Registered Dental Hygienist license and 1-2 years of experience in dental hygiene. Additional certifications such as X-ray and CPR/BLS are required, along with a valid driver's license.
Endodontist - Part Time at DOCS Health
, Georgia, United States - Full Time
Skills Needed
Endodontics, Root Canal Therapy, Pulpotomies, Apicoectomies, Digital Radiography, Clinical Documentation, Infection Control, Patient Education, Treatment Planning, Collaboration, Evidence Based Techniques
Specialization
Candidates must have a DDS or DMD from an accredited dental program and completion of an accredited Endodontics residency program. An active state dental license and CPR/BLS certification are also required.
Dentist - Part Time at DOCS Health
Fort Carson, Colorado, United States - Full Time
Skills Needed
Comprehensive Dental Care, Patient Relationships, Advanced Technology, Digital Practice, Collaboration, Quality Care
Specialization
Candidates must have a DMD or DDS from an accredited U.S. program and an active state dental license. Additional requirements include CPR/BLS certification and passing background checks.
RHRP - Dentist at DOCS Health
Munhall, Pennsylvania, United States - Full Time
Skills Needed
General Dentistry, Endodontics, Oral Surgery, Mobile Dentistry, Cpr Certification, Bls Certification, Computer Proficiency, Military Experience
Specialization
Candidates must have an active state dental license with no restrictions and CPR/BLS certification. Experience with mobile dentistry and military settings is preferred.
Experience Required
Minimum 2 year(s)
Orthodontic Dental Assistant - Part Time at DOCS Health
Fort Meade, Maryland, United States - Full Time
Skills Needed
Orthodontic Techniques, Impressions, Itero Scanning, Invisalign, Patient Rapport, Communication, Dental Software, Equipment Operation, Procedure Setup, Biohazard Disposal, Sterilization, Infection Control, Clerical Reporting, X Ray Certification, Cpr Certification, Danb Certification
Specialization
Candidates must have a current Dental Assistant License and a minimum of 2 years of orthodontic experience. Additional certifications required include X-Ray and CPR/BLS.
Experience Required
Minimum 2 year(s)
Chasseur Bagagiste F/H at Accor
Paris, Ile-de-France, France - Full Time
Skills Needed
Customer Service, Attention To Detail, Flexibility, Organization, Communication, Problem Solving, Confidentiality, Adaptability
Specialization
A strong sense of customer service and luxury quality is essential, along with good listening skills and the ability to anticipate client needs. A diploma from a hospitality school is required, with a specialization in service, restaurant, or bar.
Endodontist - Part Time at DOCS Health
Campbell, Kentucky, United States - Full Time
Skills Needed
Endodontics, Root Canal Therapy, Pulpotomies, Apicoectomies, Digital Radiography, Patient Education, Clinical Documentation, Infection Control, Collaboration, Treatment Planning
Specialization
Candidates must have a DDS or DMD from an accredited U.S. dental program and completion of an accredited Endodontics residency program. An active, unrestricted Kentucky dental license and CPR/BLS certification are also required.
Experience Required
Minimum 2 year(s)
Medical Management - Supervisor Medical Review 145-4005 at CommunityCare
Tulsa, Oklahoma, United States -
Full Time

Start Date

Immediate

Expiry Date

24 Jan, 26

Salary

0.0

Posted On

26 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Analytical Skills, Problem Solving, Decision Making, Attention To Detail, Organizational Skills, Microsoft Applications, Oral Communication, Written Communication, Teamwork, Supervision, Training, Coaching, Auditing, Performance Evaluation, Healthcare Coding, Regulatory Knowledge

Industry

Insurance

Description
The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day to day operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices. KEY RESPONSIBILITIES: Provides technical expertise to Medical Review (MRE) staff including analysis, problem solving, and decision making of complex claim reviews. Identifies medical necessity and /or quality issues for further evaluation. Oversees triage of pended and high dollar claims. Collaborates with external vendors on cases meeting reinsurance thresholds and specific requirements for ASO lines of business. Works collaboratively with other departments in providing or seeking claims review and/or clinical guidance. Participates in company committees or work groups as assigned. Proactively conducts routine monitoring and identifies areas of potential fraud, waste and/or abuse (FWA). Formulates recommendations based on findings. Suggests opportunities for focused reviews. Works collaboratively with the Compliance Officer and/or Special Investigations (SIU) as needed. Coordinates and/or oversees daily activities of the MRE staff. This includes planning, implementing and evaluating MRE goals. It also includes monitoring workload, staff supervision, training, coaching, auditing, teambuilding, performance evaluation and hiring/retaining staff. Provides training for new MRE staff including one-to-one sessions as required for successful staff mastery of job tasks related to claim reviews and special projects. Develops and implements operational guidelines for applicable payment policies and/or for other processes pertaining to the medical claim review function. Seeks organizational approval as indicated. Monitors the medical claim review tracking database for quality control. Compiles and analyzes data and prepares routine compliance reports. Performs other duties as required. QUALIFICATIONS: Excellent analytical and problem-solving skills Able to work independently as well as supervise others to meet stringent deadlines Strong attention to detail. Highly organized and capable of managing multiple projects. Proficient in Microsoft applications. Possess strong oral and written communication. Ability to work as a team in a high paced environment. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE Current active, unrestrictive license to practice as a Registered Nurse (RN) in the State of Oklahoma. BSN preferred Minimum of five years combined employment in facility/provider health care settings or managed care organization. Two years supervisory experience preferred. Prefer strong clinical related background and case review experience focused in healthcare fraud, waste and abuse. Require experience or familiarity with state and federal regulations governing healthcare coding, billing and claims processing. Recognized healthcare coding certification (CPC, AHIMA, etc.) preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin
Responsibilities
The Medical Review Supervisor oversees the daily operations of the medical claim review program and guides staff in auditing and monitoring functions to identify risks and potential fraud. They also coordinate staff activities, develop operational guidelines, and monitor quality control of claim reviews.
Medical Management - Supervisor Medical Review 145-4005 at CommunityCare
Tulsa, Oklahoma, United States - Full Time
Skills Needed
Analytical Skills, Problem Solving, Decision Making, Attention To Detail, Organizational Skills, Microsoft Applications, Oral Communication, Written Communication, Teamwork, Supervision, Training, Coaching, Auditing, Performance Evaluation, Healthcare Coding, Regulatory Knowledge
Specialization
Candidates must have an active RN license in Oklahoma and a minimum of five years of experience in healthcare settings or managed care organizations. Supervisory experience and familiarity with healthcare regulations and coding are preferred.
Experience Required
Minimum 5 year(s)
Business Development Director at Onsite Wellness Group LLC
Cumberland Furnace, Tennessee, United States - Full Time
Skills Needed
Business Development, Relationship Management, Market Research, Strategic Planning, Coaching, Training, Collaboration, Customer Service, Networking, Therapeutic Processes, Healthcare Compliance, Event Planning, Sales, Leadership, Accreditation, Communication
Specialization
The position requires extensive knowledge of Onsite’s services and the ability to communicate effectively. Candidates should have experience in business development and a comprehensive understanding of healthcare regulations.
Experience Required
Minimum 5 year(s)
Business Development Director at Al Moosa Career Portal
Al Ahsa Governorate, Eastern Province, Saudi Arabia - Full Time
Skills Needed
N/A
Specialization
Candidates should have a strong background in business development and proven experience in leadership roles. Excellent communication and negotiation skills are essential.
Experience Required
Minimum 5 year(s)
Business Development Director at Qureos Inc
Riyadh, Riyadh Region, Saudi Arabia - Full Time
Skills Needed
Business Development, Sales Leadership, Experiential Marketing, Immersive Installations, Exhibitions, Entertainment Venues, Events Production, Cultural Institutions, Strategic Thinking, Consultative Selling, Crm Proficiency, Relationship Building, Market Intelligence, Team Building, Communication Skills, Cultural Intelligence
Specialization
Candidates must have over 8 years of experience in business development or sales leadership in Saudi Arabia, with a proven track record of closing high-value deals. An established network in the KSA entertainment and tourism sectors, along with exceptional communication skills in Arabic and English, is essential.
Experience Required
Minimum 10 year(s)
Assistant Fitness Manager at EōS Fitness
Santa Barbara, California, United States - Full Time
Skills Needed
Leadership, Interpersonal Skills, Sales, Customer Service, Communication, Relationship Building, Detail Orientation, Problem Solving, Time Management, Organizational Skills, Record Keeping, Fitness Knowledge, Team Management, Training, Motivation, Fitness Certifications
Specialization
Candidates should have 2 years of management experience and 2-3 years of customer service experience. A valid Personal Training certification and CPR certification within 30 days of hire are also required.
Experience Required
Minimum 2 year(s)
ALTERATIONS ASSOCIATE at Von Maur/Dry Goods
Livonia, Michigan, United States - Full Time
Skills Needed
Customer Experience, Garment Alterations, Sewing, Measuring, Fitting, Repairing, Cleaning, Ironing, Steaming, Attention To Detail, Communication, Teamwork, Problem Solving, Time Management, Customer Service, Basic Sewing Techniques, Advanced Alterations
Specialization
Candidates must be professionally competent in all basic and most advanced alterations. The role requires a friendly demeanor and the ability to maintain a clean work area.
ALTERATIONS ASSOCIATE at Von Maur/Dry Goods
Rochester Hills, Michigan, United States - Full Time
Skills Needed
Customer Experience, Garment Alterations, Sewing, Measurement, Fitting, Repair, Ironing, Steaming, Attention To Detail, Cleanliness, Basic Sewing, Moderate Sewing, Tailoring, Formal Wear, Friendly Communication, Customer Service
Specialization
Candidates must be professionally competent in all basic and most advanced alterations. Experience with diverse styles of women's garments is essential.
Operations Manager at Apparel Group
, , Saudi Arabia - Full Time
Skills Needed
Sales Management, Customer Service, Team Leadership, Training And Development, Inventory Management, Visual Merchandising, Operational Efficiency, Performance Evaluation, Cost Management, Recruitment, Communication, Succession Planning, Loss Prevention, Project Management, Brand Management, Market Awareness
Specialization
The role requires strong experience in sales management and operational oversight, with a focus on employee development and performance evaluation. Candidates should have a proven track record in retail management and effective communication skills.
Experience Required
Minimum 5 year(s)
Orthodontist - Part Time at DOCS Health
Columbia, South Carolina, United States - Full Time
Skills Needed
Organizational Skills, Patient Care, Communication Skills, Interpersonal Skills, Diagnostic Procedures, Treatment Planning, Appliance Adjustment, Education Skills, Professionalism, Positive Attitude, Calm Approach, Fairness, Consistency, X Ray Utilization, Dental Instruments, Relationship Building
Specialization
Candidates must have a DDS or DMD from an accredited US program with an Orthodontics Specialty and an active South Carolina Dental License. Strong communication and interpersonal skills, along with proficiency in Microsoft Suite, are also required.
Experience Required
Minimum 2 year(s)
Orthodontist - Part Time at DOCS Health
Town of Le Ray, New York, United States - Full Time
Skills Needed
Orthodontics, Patient Care, Communication Skills, Organizational Skills, Microsoft Suite, Diagnostic Tools, Treatment Planning, Interpersonal Skills, Workflow Management, Relationship Building, X Rays, Fixed Appliances, Removable Appliances, Aligners, Adjustments, Education
Specialization
Candidates must have a DDS or DMD from an accredited program with an Orthodontics Specialty and an active, unrestricted State Dental License. Proficiency in essential orthodontic procedures and strong interpersonal skills are also required.
Experience Required
Minimum 2 year(s)
Orthodontist - Part Time at DOCS Health
, North Carolina, United States - Full Time
Skills Needed
Orthodontics, Patient Care, X Rays, Diagnostic Tools, Fixed Appliances, Removable Appliances, Aligners, Patient Education, Organizational Skills, Microsoft Suite, Workflow Management, Relationship Building, Clinical Autonomy, Background Check, Drug Screening, Vaccinations
Specialization
Candidates must have a DDS or DMD from an accredited program with an Orthodontics Specialty and an active, unrestricted State Dental License. Proficiency in essential orthodontic procedures and strong organizational skills are also required.
Experience Required
Minimum 2 year(s)
Endodontist - Part Time at DOCS Health
Fort Stewart, Georgia, United States - Full Time
Skills Needed
Endodontics, Root Canal Therapy, Pulpotomies, Apicoectomies, Digital Radiography, Patient Education, Clinical Documentation, Infection Control, Collaboration, Treatment Planning
Specialization
Candidates must have a DDS or DMD from an accredited dental program and completion of an accredited Endodontics residency program. An active, unrestricted state dental license and CPR/BLS certification are also required.
Experience Required
Minimum 2 year(s)
Orthodontist - Part Time at DOCS Health
, Puerto Rico, United States - Full Time
Skills Needed
Orthodontics, Patient Care, X Rays, Diagnostic Tools, Fixed Appliances, Removable Appliances, Aligners, Patient Education, Organizational Skills, Microsoft Suite
Specialization
Candidates must have a DDS or DMD from an accredited program with an Orthodontics Specialty and an active, unrestricted State Dental License. Proficiency in essential orthodontic procedures is required.
Experience Required
Minimum 2 year(s)
Hygienist - Part Time at DOCS Health
Calcium, New York, United States - Full Time
Skills Needed
Dental Hygiene, Patient Education, X Ray Certification, Cpr Certification, Gingivitis Assessment, Periodontitis Assessment, Fluoride Application, Treatment Planning, Patient Communication, Record Keeping, Team Collaboration, Hipaa Knowledge, Denticon Knowledge
Specialization
Candidates must have an active Registered Dental Hygienist license and 1-2 years of experience in dental hygiene. Additional certifications such as X-ray and CPR/BLS are required, along with a valid driver's license.
Endodontist - Part Time at DOCS Health
, Georgia, United States - Full Time
Skills Needed
Endodontics, Root Canal Therapy, Pulpotomies, Apicoectomies, Digital Radiography, Clinical Documentation, Infection Control, Patient Education, Treatment Planning, Collaboration, Evidence Based Techniques
Specialization
Candidates must have a DDS or DMD from an accredited dental program and completion of an accredited Endodontics residency program. An active state dental license and CPR/BLS certification are also required.
Dentist - Part Time at DOCS Health
Fort Carson, Colorado, United States - Full Time
Skills Needed
Comprehensive Dental Care, Patient Relationships, Advanced Technology, Digital Practice, Collaboration, Quality Care
Specialization
Candidates must have a DMD or DDS from an accredited U.S. program and an active state dental license. Additional requirements include CPR/BLS certification and passing background checks.
RHRP - Dentist at DOCS Health
Munhall, Pennsylvania, United States - Full Time
Skills Needed
General Dentistry, Endodontics, Oral Surgery, Mobile Dentistry, Cpr Certification, Bls Certification, Computer Proficiency, Military Experience
Specialization
Candidates must have an active state dental license with no restrictions and CPR/BLS certification. Experience with mobile dentistry and military settings is preferred.
Experience Required
Minimum 2 year(s)
Orthodontic Dental Assistant - Part Time at DOCS Health
Fort Meade, Maryland, United States - Full Time
Skills Needed
Orthodontic Techniques, Impressions, Itero Scanning, Invisalign, Patient Rapport, Communication, Dental Software, Equipment Operation, Procedure Setup, Biohazard Disposal, Sterilization, Infection Control, Clerical Reporting, X Ray Certification, Cpr Certification, Danb Certification
Specialization
Candidates must have a current Dental Assistant License and a minimum of 2 years of orthodontic experience. Additional certifications required include X-Ray and CPR/BLS.
Experience Required
Minimum 2 year(s)
Chasseur Bagagiste F/H at Accor
Paris, Ile-de-France, France - Full Time
Skills Needed
Customer Service, Attention To Detail, Flexibility, Organization, Communication, Problem Solving, Confidentiality, Adaptability
Specialization
A strong sense of customer service and luxury quality is essential, along with good listening skills and the ability to anticipate client needs. A diploma from a hospitality school is required, with a specialization in service, restaurant, or bar.
Endodontist - Part Time at DOCS Health
Campbell, Kentucky, United States - Full Time
Skills Needed
Endodontics, Root Canal Therapy, Pulpotomies, Apicoectomies, Digital Radiography, Patient Education, Clinical Documentation, Infection Control, Collaboration, Treatment Planning
Specialization
Candidates must have a DDS or DMD from an accredited U.S. dental program and completion of an accredited Endodontics residency program. An active, unrestricted Kentucky dental license and CPR/BLS certification are also required.
Experience Required
Minimum 2 year(s)