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: 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...
Job 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...
Job 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...
Job 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...
Job 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...
Job Title: Nurse Paralegal Job Responsibilities: - Review and... analyze medical records to evaluate medical issues related to litigation processes. - Prepare objective medical chronologies and medical summaries of pertinent medical records. - Create medical audits of treatment expenses for use in the evaluation...
Job 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...
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 within the organization. The role involves developing and implementing controls and cost-effective approaches to minimize risk specifically...
Job Title: Experienced Paralegal – Litigation / Healthcare Job... Responsibilities: - Obtain, review, and analyze documents, including medical records, financial records, tax and employment records, or any other relevant information. - Create medical record chronologies to assist in case preparation. - Prepare for trial...
Job Title: Legal Nurse Consultant Job Responsibilities: - Prepare and... explicit details about the education and experience requirements for the Legal Nurse Consultant position. However, typically,... a Legal Nurse Consultant would need to... have a nursing degree and relevant experience in healthcare...
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...
Title: Medicaid and Probate Paralegal Job Responsibilities: The Medicaid and Probate... Paralegal at the law firm... will assist families in navigating the complex processes of public benefits, including Medicaid and VA planning. The role involves handling probate matters for deceased clients and...
Job Title: Medicaid Paralegal Job Responsibilities: - Work in the... home care. - Although prior experience in Medicaid planning is not required, the paralegal should utilize any prior... law experience to benefit their role. - Provide support to attorneys working in the estate plannin...
Job Title: Medicaid Paralegal Job Responsibilities: - Work within the... Medicaid planning department of the law firm. - Collaborate with attorneys, clients, and their families to assist clients in navigating the Medicaid application process for seniors requiring nursing home care. - Provide support for...
is the Atlanta outpost of an international firm. Although this firm is international, it still has a decidedly regional feel to it, and it international only to service certain valued clients. Life is reasonably good in the Atlanta...
industry. We not only have the best **Members Only** positions, but we also have the most. Nurse Paralegal This candidate will work... closely and in collaboration with attorneys and the legal team by analyzing medical records, gathering pertinent case document...
legal industry. We not only have the best **Members Only** positions, but we also have the most. Nurse Paralegal The candidate should have... 5+ years clinical hospital experience. Review, analyze, evaluate medical records and issues pertaining to the litigation proc...