Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: - Investigate and process medical necessity appeal requests from members and providers. - Support legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests. - Act as a resource for both...
Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: The Nurse Appeals is tasked with investigating and processing medical necessity appeals requests from both members and providers. This role supports legal, management, and executive leadership by managing State Fair Hearing and External Medical...
Title: Investigator Senior - Pharmacy Job Responsibilities: The Investigator Senior - Pharmacy is responsible for independently identifying, investigating, and developing complex healthcare cases against perpetrators of healthcare fraud to recover corporate and client funds paid on fraudulent claims. Key responsibilities include: - Conducting...
Contract Manager The candidate will manage the full life cycle of Pharmacy Benefit Management (PBM) contracts from RFP through client contract execution. Oversee the contract approval process, ensuring compliance, version control, and support the negotiation and execution of standard and...
The following jobs are no longer active but were real openings previously posted by employers. These listings provide valuable insight into employer hiring trends and frequently lead to job offers. In many cases, employers are still hiring or open to strong candidates even if no new job is posted. Applying to these listings often makes you the only applicant, increasing your chances of being hired.
Care Regional Expansion Consultant - Central / Western Region Duties: The candidate develops and executes strategies for a function or discipline that span a large business unit or multiple markets/sites. Directs others to resolve business problems that affect multiple functions or disciplines. Product, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external). Develops, maintains, and executes Complex C... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Care Expansion Consultants (State level) The candidate develops and executes strategies for a function or discipline that span a large business unit or multiple markets/sites. Directs others to resolve business problems that affect multiple functions or disciplines. Responsible for achieving growth goals. Develops, maintains, and executes Complex Care market expansion strategies for region. Serves as technical expert for Complex Care Products to state governments, in... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Legal Analyst The candidate will research government regulations and guidance on the health care industry, including on PBM operations. Will summarize and communicate regulations to management and other internal stakeholders. Utilize various hardcopy and electronic resources to research health care and related regulations. Identify laws and regulations that affect PBM operations, including those related to Medicare, Medicaid, and the Patient Protection... and Affordable Care Ac... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Director of Billing Compliance - UC Health Business Center - Corporate Compliance Duties: Will assist company and its entities to provide care and to conduct business in accordance with applicable medicare and medicaid coding, billing and reimbursement... regulations and direct a comprehensive annual schedule of compliance auditing and monitoring reviews as well as special compliance audit requests throughout company. Develop and manage the overall billing compliance plan and p... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Director of Billing Compliance - UC Health Business Center - Corporate Compliance Duties: Will assist company and its entities to provide care and to conduct business in accordance with applicable medicare and medicaid coding, billing and reimbursement... regulations and direct a comprehensive annual schedule of compliance auditing and monitoring reviews as well as special compliance audit requests throughout company. Develop and manage the overall billing compliance plan and p... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Program Director - Strategic Medicaid Partnerships The candidate will... identify, design and implement strategic partnerships with a wide range of organizations to expand and enhance capabilities to support the Medicaid business and long-range Growth... plan. Will apply knowledge about the unique needs of specialized service populations (including people with intellectual and developmental disabilities, children in foster care, people with serious mental illness or other disabili... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Corporate Counsel – Health Care Duties: Provide counsel and advice on all aspects of health care regulation including federal and state fraud, waste and abuse laws, Medicare and Medicaid requirements, the Health Insurance... Portability and Accountability Act and the HITECH Act with emphasis on federal and state laws, rules, and regulations relating to the provision of health care services by Nurse Practitioners and Physician Assistants Review, draft, and negotiate contract... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Program Director - Strategic Medicaid Partnerships The candidate will... identify, design and implement strategic partnerships with a wide range of organizations to expand and enhance capabilities to support the Medicaid business and long-range Growth... plan. Will apply knowledge about the unique needs of specialized service populations (including people with intellectual and developmental disabilities, children in foster care, people with serious mental illness or other disabili... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Legal Writer - Medicaid The candidate will contribute... well-written, informative articles to a portfolio of legal websites. Will read statutes, understand legal issues, and put the law into plain English for a general audience. Must have a law degree and 3+ years of experience as a practicing lawyer. Estate planning experience in the field of asset protection for Medicaid planning purposes is essential.... Ability to write in an authoritative, neutral tone, is required. Should a... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here
Counsel – Health Care Pharmacy Duties: Provide health care regulatory guidance and advice relating to the operation of pharmacies. Will provide guidance and analysis on a wide variety of regulatory issues impacting pharmacies and also provide contract counseling and drafting, assistance with contract disputes, and training to internal clients on legal issues and compliance. Provide legal services similar to those mentioned above to other areas of business. Prov... read more
Note: This job is no longer active. It was originally posted on [Date] and is part of LawCrossing’s historical archive of legal jobs. While the position may have been filled, employers often remain open to exceptional candidates for similar roles. LawCrossing has tracked this employer's hiring activity for over 25 years. This listing is provided for informational and outreach purposes and may still lead to employment. Learn more about archive jobs and how powerful they are for your search, click here