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...
Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: The Nurse Appeals role involves several critical responsibilities aimed at ensuring that medical necessity appeals are investigated and processed effectively. The key duties include: - Supporting legal, management, and executive leadership by managing State Fair...
Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: The Nurse Appeals role involves a range of responsibilities focused on managing and processing medical necessity appeals from members and providers. Key duties include: - Supporting legal, management, and executive leadership by managing State Fair...
Title: Nurse Appeals (Grievance & Appeals) Job Responsibilities: The Nurse Appeals role involves investigating and processing medical necessity appeal requests from members and providers. Key responsibilities include: - Supporting legal, management, and executive leadership by managing State Fair Hearing and External Medical Review...
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: 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: 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: 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: Counsel, Healthcare Transactions & Regulatory Data Job Responsibilities: - Advise on legal and regulatory issues related to corporate transactions such as acquisitions, dispositions, operator transitions, and facility closures, with a specific focus on healthcare considerations. - Lead or support the preparation and...
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...