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The following jobs are no longer active but were real openings previously posted by employers.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.
/ Compliance Specialist The candidate will coordinate with various internal departments and committees to develop processes and document, manage, and monitor policies and procedures to ensure operational and procedural compliance with state and federal regulations. Will work closely with legal departments and translate legal requirements/regulations and facilitate risk assessments to highlight compliance process vulnerabilities. Recommend and build new policies 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Note: This job is no longer active.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 Policy, Complex Care Products The candidate will be responsible for ensuring positive policy position for organization related to Complex Care Products including Medicaid Long Term Care, Home... and Community Based Services, Dual Special Needs Plans. Will be responsible for positively positioning organization with national stakeholders and in national forums to further organizational position. Responsible for identification of appropriate research projects which may... 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 Consultant 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). Responsible for achieving growth goals. Develops, maintains, and executes Complex Care... 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 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
General Counsel The candidate responsibilities will include: Assists the General Counsel of **Members Only** in settlement discussions/negotiations. Interface with regulators, including providing assis... 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 - Regulatory Policy / Privacy The candidate will oversee and manage staff and vendors supporting company's Medicare Advantage, Part D and... Medicare Supplement (Medicare Programs) regulatory... integration/implementation, compliance training, policies and procedures, and privacy compliance activities. Will track, gather, and draft comment letters on draft statutes, regulations and guidance impacting company's Medicare Programs. Track timely implementation... of final statut... 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
Requisition Number: 14-0894 Associate General Counsel II The candidate will assist the General Counsel. Will provide legal advice on a wide range of corporate matters. Work closely with members of management and others to ensure compliance with all applicable legal requirements, including federal and state Medicaid and Medicare regulations. Prepare and review... contracts and/or agreements between the corporation and outside organizations with heavy emphasis on IT related cont... 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
Associate General Counsel The candidate will assist the General Counsel of Firm. Will provide legal advice on a wide range of corporate matters. Work closely with members of management and others to ensure compliance with all applicable legal requirements, including federal and state Medicaid and Medicare regulations. Prepare and review... contracts and/or agreements between the corporation and outside organizations with heavy emphasis on IT related contracts. Provide legal adv... 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
Medicare Advantage Attorney The candidate... must have 5+ years of experience in a corporate legal department or law firm, have a top law school academic record, have top legal writing, drafting, and research skills, and be able to effectively work in a growing dynamic business.... 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