Title: Grievance & Appeals Nurse (RN) Job Responsibilities: The Grievance & Appeals Nurse (RN) is responsible for managing and processing medical necessity appeals requests from members and providers. Key responsibilities include: - Supporting legal, management, and executive leadership by overseeing State Fair Hearing...
Title: Grievance & Appeals Nurse (RN) Job Responsibilities: The primary responsibility of the Grievance & Appeals Nurse is to investigate and process medical necessity appeals requests from members and providers. This role supports legal, management, and executive leadership by managing State Fair...
Title: Grievance & Appeals Nurse (RN) Job Responsibilities: - Investigate and process medical necessity appeals requests from members and providers. - Support legal, management, and executive leadership in managing State Fair Hearing and External Medical Review requests. - Act as a resource for clinical...
Title: Grievance & Appeals Nurse (RN) Job Responsibilities: - Investigate and process medical necessity appeals requests from members and providers. - Support legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests. - Act as...
Title: Grievance & Appeals Nurse (RN) Job Responsibilities: - The Nurse Appeals is responsible for investigating and processing medical necessity appeals requests from members and providers. - Supports legal, management, and executive leadership by managing State Fair Hearing and External Medical Review requests. -...
Title: Lead Counsel, Practice Management Job Responsibilities: - Serve as a principal legal advisor for CORE Ventures and The US Oncology Network, providing sophisticated, solutions-oriented guidance on a broad range of legal, regulatory, and business matters affecting oncology practice management. - Lead and...
Title: Sr Investigator Job Responsibilities: The Sr Investigator is tasked with the independent identification, investigation, and development of complex cases against individuals or entities perpetrating healthcare fraud. The primary aim is to recover corporate and client funds that have been paid on...
Title: Senior Associate Counsel Job Responsibilities: - Provide comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence within a hospital setting. - Advise hospital leadership and procurement teams on the legal implications of...
Title: Assistant General Counsel - Commercial Transactions Job Responsibilities: The Assistant General Counsel - Commercial Transactions is a leadership position responsible for providing exceptional legal advice to one of the company's growing sectors, particularly in the pharmaceutical distribution, manufacturing, precision medicine, and...
General Counsel - Commercial Transactions Job Title Assistant General Counsel - Commercial Transactions Job Responsibilities The Assistant General Counsel for Commercial Transactions is tasked with providing exceptional legal advice to one of the company's expanding sectors, particularly in pharmaceutical distribution, manufacturing, precision...
potential sources of loss to minimize risk within the organization. The role involves developing and implementing controls and cost-effective approaches to minimize risk specifically in Medicaid operations. Key responsibilities include: -... Assessing and communicating contractual obligations regarding business risks with va...
Title: Senior Risk Management Professional Job Responsibilities: The Senior Risk Management Professional is responsible for identifying and analyzing potential sources of loss to minimize risk. The role involves developing and implementing controls and cost-effective approaches to minimize risk within the Payment Integrity...
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...