Title Legal Counsel, Carelon Contracting Job Responsibilities The Legal Counsel for Carelon Contracting is tasked with providing legal advice and recommendations for initiatives and projects that align with clients' overall objectives and needs. This role focuses on large-scale and/or high...
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 Senior Legal Counsel I Job Responsibilities - Provides legal advice and counsel to corporate officers, managers, and employees of the Company and its subsidiaries, affiliates, and joint ventures across various lines of business under the general direction of Legal...
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...
The following jobs are no longer active but were real openings previously posted by employers.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.
Legal Specialist II or Legal Specialist Senior Duties: The candidate will provide legal support services for one or more primarily supporting the legal area dedicated to support of Provider Solutions business area including commercial, Medicaid and Medicare products. Will draft contract... templates and amendments to provider agreements. Respond to proposed changes to contract language. Conduct legal research and analysis, and recommend appropriate course of action and next ste... 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Note: This job is no longer active.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
Compliance Director ( Regulatory ) The candidate will provide regulatory and legal support for EyeMed Vision Care, LLC and its related entities regarding, government programs (. Medicaid and Medicare), Federal and State requirements.... Will handle State Department of Insurance regulatory issues, client and vendor contract drafting/negotiations, and other general client and/or regulated matters. Works with key functional and operating groups in the US and Puerto Rico to supp... 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
Manager The candidate manage/oversee projects, initiatives, regulatory audits or exams, internal audits, accreditations, on-site reviews, risk assessments; audit planning, conducting mock audits, conducting audit training, managing audit evidence preparation, assessing audit preparedness. Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates. Maintain knowledge of laws, regulations, company strategies to asse... 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
I Compliance The candidate compares compliance performance to that of other organizations through benchmarking. Directs and leads compliance programs with multiple layers, objectives, tasks, stakeholders, requirements; assess and report on program/process effectiveness; creates policies, procedures and tools needed to operate daily function of program; manage/oversee/influence resources impacting projects or programs from matrixed organizations under different leade... 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
Investigator The candidate will be responsible for investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices on an enterprise wide basis for company's Special Investigations Unit. Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers. Prepares statistical/financial analyses and reports to document findings and maintain... 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
Investigator The candidate will be responsible for investigating, collecting, researching and analyzing billing data in order to detect fraudulent, abusive or wasteful activities/practices on an enterprise wide basis for company's Special Investigations Unit. Using appropriate system tools, analyzes data to detect fraudulent, abusive or wasteful payments to providers and subscribers. Prepares statistical/financial analyses and reports to document findings and maintain... 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
VP Payment Innovation Reporting/Tools and Payment Models Duties: Develop total value payment models that incentivize improvements in health care quality and outcomes while reducing unnecessary cost and resource use associated with care delivery. Oversee the complementary tools and applications that support population health management, and make cost and quality information available to physicians and their patients. Leads the development and maintenance of shared savin... 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
VP Payment Models, Analytics and Reporting Duties: Responsible for leading the development of payment models to support migration from volume to value based contracting. Position has end-to-end financial and analytical accountability for the company’s value-based payment models (., shared savings/shared risk, bundle payment, pay for performance). As the healthcare industry continues to transform, moving away from traditional fee-for-service reimbursement, this rol... 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 or Legal Counsel Senior Candidate will be responsible for helping provide legal support on healthcare privacy and related data security issues.... 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 Senior/Associate General Counsel - Duties: Actively collaborates with business team to assist in achieving targeted business goals. Serves as a strategic partner with President of Ohio plan and President’s team. Provides legal solutions to a wide range of difficult or new problems. Develops recommendations and solutions that are thorough, practical and consistent with organizational objectives. Works collaboratively with other attorneys and paralegals. Assum... 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