Medical Review Supervisor

4 weeks ago


Tulsa, Oklahoma, United States CommunityCare Full time

The Medical Review Supervisor plays a crucial role in overseeing the day-to-day operations of CommunityCare's medical claim review program. This involves guiding individuals in implementing auditing and monitoring functions to identify areas of risk and potential fraud, waste, and abuse related to provider billing practices.

The Supervisor provides technical expertise to Medical Review staff, including analysis, problem-solving, and decision-making of complex claim reviews. They identify medical necessity and/or quality issues for further evaluation and oversee the triage of pended and high-dollar claims.

Collaborating with external vendors on cases meeting reinsurance thresholds and specific requirements for ASO lines of business is also a key responsibility. The Supervisor works collaboratively with other departments to provide or seek claims review and/or clinical guidance.

Key responsibilities include:

  • Providing technical expertise to Medical Review staff
  • Identifying medical necessity and/or quality issues
  • Overseeing triage of pended and high-dollar claims
  • Collaborating with external vendors
  • Working with other departments

The Medical Review Supervisor also coordinates and/or oversees daily activities of the MRE staff, including planning, implementing, and evaluating MRE goals. They monitor workload, staff supervision, training, coaching, auditing, teambuilding, performance evaluation, and hiring/retaining staff.

Additionally, the Supervisor 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.

Developing and implementing operational guidelines for applicable payment policies and/or for other processes pertaining to the medical claim review function is also a key responsibility. The Supervisor seeks organizational approval as indicated.

Monitoring the medical claim review tracking database for quality control, compiling and analyzing data, and preparing routine compliance reports are also essential duties.

The Medical Review Supervisor must possess excellent analytical and problem-solving skills, be able to work independently as well as supervise others to meet stringent deadlines, and have strong attention to detail. They must also be highly organized and capable of managing multiple projects.

Proficient in Microsoft applications and possessing strong oral and written communication skills are also essential. The ability to work as a team in a high-paced environment is critical.

Successful completion of a Health Care Sanctions background check is required. A current active, unrestrictive license to practice as a Registered Nurse (RN) in the State of Oklahoma is also necessary.

Preferred qualifications include a BSN, minimum of five years combined employment in facility/provider health care settings or managed care organization, and minimum of two years supervisory experience. Strong clinical related background and case review experience focused in healthcare fraud, waste, and abuse are also preferred.

Experience or familiarity with state and federal regulations governing healthcare coding, billing, and claims processing is required. Recognized healthcare coding certification (CPC, AHIMA, etc.) is 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.



  • Tulsa, Oklahoma, United States CommunityCare Full time

    The Medical Review Supervisor plays a pivotal role in overseeing the day-to-day operations of CommunityCare's medical claim review program. This position is responsible for guiding individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste, and abuse related to provider billing practices.Key...

  • Medical Reviewer LPN

    3 weeks ago


    Tulsa, Oklahoma, United States Health Care Service Corporation Full time

    Job SummaryThis position is responsible for conducting pre-authorization reviews in accordance with medical contracts and regulations, medical criteria, utilization review, and quality of care.Key ResponsibilitiesLPN with valid, current, unrestricted clinical license in the state of operations.3 years of clinical experience in physician office, hospital, or...


  • Tulsa, Oklahoma, United States CommunityCare Full time

    Job SummaryThe Medical Review Supervisor at CommunityCare is responsible for overseeing the day-to-day operations of our medical claim review program. This includes guiding individuals in implementing auditing and monitoring functions to identify areas of risk and potential fraud, waste, and abuse related to provider billing practices.Key...


  • Tulsa, Oklahoma, United States Oklahoma State University Medical Center Full time

    Job SummaryThe Registration Supervisor is responsible for the daily operations of the Emergency Department registration area and has 24-hour accountability. A primary focus of this position is to collect cash and ensure ED accounts have proper billing information.Key ResponsibilitiesTrain employees and conduct re-training sessionsReview competencies with...


  • Tulsa, Oklahoma, United States Saint Francis Hospital, Inc. Full time

    Job Summary: We are seeking a highly skilled Medical Laboratory Supervisor to oversee the daily operations of our laboratory section. The ideal candidate will have a strong background in medical technology and excellent leadership skills.Responsibilities:Supervise laboratory personnel and ensure the proper performance of all lab procedures.Develop and...

  • Nursing Supervisor

    3 weeks ago


    Tulsa, Oklahoma, United States Cearu Medical Resort Full time

    Nursing Supervisor Job DescriptionThe Cearu Medical Resort is seeking a skilled and compassionate Nursing Supervisor to join our team. As a key member of our nursing department, you will be responsible for providing direct nursing care to our residents and supervising the day-to-day activities of our nursing assistants.Key Responsibilities:Provide direct...


  • Tulsa, Oklahoma, United States Cearu Medical Resort Full time

    Nursing Care Supervisor Job DescriptionCearu Medical Resort is seeking a skilled Nursing Care Supervisor to join our team. As a key member of our nursing staff, you will be responsible for providing direct nursing care to our residents and supervising the day-to-day nursing activities performed by nursing assistants.Key Responsibilities:Provide direct...

  • Clinical Supervisor

    4 weeks ago


    Tulsa, Oklahoma, United States A Path of Care Home Health Full time

    About A Path of Care Home HealthA Path of Care Home Health is a leading provider of skilled care and support services, enabling patients to live safely and independently in their own homes. Our team of dedicated professionals works closely with doctors to develop personalized care plans that cater to the unique needs of each patient.We strive to demonstrate...


  • Tulsa, Oklahoma, United States Cearu Medical Resort Full time

    Career Opportunities at Cearu Medical ResortWe are seeking a seasoned and compassionate Charge Nurse to join our team at Cearu Medical Resort. As a key member of our nursing department, you will be responsible for providing direct nursing care to our residents and supervising the day-to-day nursing activities performed by our nursing assistants.About the...


  • Tulsa, Oklahoma, United States Stand-By Personnel Full time

    **Structural Lead / Supervisor**Stand-By Personnel is seeking a skilled Structural Lead / Supervisor to oversee the construction of structural steel components, ensuring quality, cost control, and on-time delivery of parts.**Key Responsibilities:**Leading the manufacturing team and suppliers in constructing structural steel components.Creating and managing...

  • Medical Assistant

    3 weeks ago


    Tulsa, Oklahoma, United States Ardent Health Full time

    About the Role:We are seeking a skilled Medical Assistant to join our Endocrinology team in Tulsa, OK. As a Medical Assistant, you will play a vital role in providing exceptional patient care and supporting our healthcare team.Key Responsibilities:Transport, room, and prepare patients for physician, advanced practice provider, and nurse clinic...


  • Tulsa, Oklahoma, United States Trinity Employment Specialists Full time

    Job SummaryWe are seeking a highly organized and detail-oriented Medical Billing Specialist to join our team at Trinity Employment Specialists in Tulsa, OK. As a Medical Billing Specialist, you will play a vital role in ensuring timely reimbursement for services rendered by our clients. Your responsibilities will include managing and maintaining accurate...

  • Front Desk Supervisor

    4 weeks ago


    Tulsa, Oklahoma, United States Family & Children's Services Full time

    Job SummaryWe are seeking a highly skilled and experienced Front Desk Supervisor to join our team at Family & Children's Services. The successful candidate will provide direct supervision to front desk specialists, ensuring consistent workflows and processes. This role requires strong leadership and communication skills, as well as the ability to work...


  • Tulsa, Oklahoma, United States Q Full time

    Job SummaryWe are seeking a highly skilled Field Operations Supervisor to join our team. As a Field Operations Supervisor, you will be responsible for managing all outside field operations in the assigned geographic area, ensuring the efficient and timely completion of customer fulfillment requests for premise installation and repair.Key...


  • Tulsa, Oklahoma, United States ForTec Medical Full time

    Job SummaryForTec Medical is seeking a highly motivated Clinical Technology Specialist to join our operations team. As a key member of our team, you will be responsible for delivering innovative surgical technologies to hospitals and surgery centers for use in scheduled procedures.Key ResponsibilitiesOperate surgical lasers and other medical devices,...

  • Shift Supervisor

    1 month ago


    Tulsa, Oklahoma, United States Tulsa County, OK Full time

    Job SummaryUnder general direction, the Shift Supervisor will oversee the daily operations of the Juvenile Detention Home, ensuring compliance with safety and security requirements. The successful candidate will supervise assigned personnel and juveniles, responsible for overseeing all facets of program activities.Key ResponsibilitiesMaintain compliance with...


  • Tulsa, Oklahoma, United States Family & Children's Services Full time

    Job Title: Front Desk Supervisor IIFamily & Children's Services is seeking a highly skilled and experienced Front Desk Supervisor II to join our team. As a key member of our front desk operations, you will be responsible for providing direct supervision to front desk specialists, coordinating front desk staff and responsibilities, and ensuring consistent...

  • Production Supervisor

    1 month ago


    Tulsa, Oklahoma, United States Greenheck Full time

    Job Title: Production SupervisorGreenheck Group is a leading manufacturer of commercial HVAC products, and we're seeking a Production Supervisor to join our team. As a key member of our operations team, you will be responsible for supervising manufacturing operations, ensuring that production plans are met, and maintaining a safe and efficient work...


  • Tulsa, Oklahoma, United States VetJobs Full time

    Job Title: Field Operations SupervisorAre you ready to launch your career with one of the nation's fastest-growing fiber-optic powerhouses? Welcome to Metronet and Vexus, where we don't just build networks; we build communities.As a Field Operations Supervisor, you will be responsible for managing all MetroNet outside field operations in the assigned...


  • Tulsa, Oklahoma, United States TAT Technologies Ltd Full time

    Job SummaryTAT Technologies Ltd is seeking a highly motivated and experienced OEM Production Supervisor to lead our thermal energy production operations. The successful candidate will be responsible for overseeing the production processes, ensuring availability of necessary material, equipment, and labor resources, and implementing action plans to ensure a...