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: 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...
The following jobs are no longer active but were real openings previously posted by employers.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.
Staff Counsel I The candidate will provide in depth analysis, research, presentations, and support for legal issues, whether transactional, non-litigation, or litigation. Draft, review structure and negotiate health care provider contracts. Provide counsel on the Stark law, anti-kickback statute, civil monetary penalties law and other fraud and abuse matters. Work with clients on Medicare and Medicaid regulatory issues.... Provide legal advice and direction on corporate structu... 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Note: This job is no longer active.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
Legal Assistant Duties: Provides support to four attorneys and manages personal injury claims that are not in litigation. Set workflows; track medical treatment; acquire medical records and bills; communicate with clients and insurance adjusters; process medical payments claims; summarize medical records; help prepare settlement demands; accurately verify medical account balances; acquire liens from Medicaid, Medicare, and health insurance companies;... accurately prepare settl... 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
Program Director - Strategic Medicaid Partnerships The candidate will... identify, design and implement strategic partnerships with a wide range of organizations to expand and enhance capabilities to support the Medicaid business and long-range Growth... plan. Will apply knowledge about the unique needs of specialized service populations (including people with intellectual and developmental disabilities, children in foster care, people with serious mental illness or other disabili... 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
Legal Assistant The candidate will be answering incoming phone calls, setting up files in client management software, proactively tracking clients' medical treatment, ordering medical records and bills. Will be setting up claims with Medicaid and Medicare, reviewing medical records, preparing... settlement packages, verifying accounts balances, communicating with clients, doctors, and insurance adjusters. A legal assisting/paralegal degree is preferred. Should have prior legal... 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
Program Director - Strategic Medicaid Partnerships The candidate will... identify, design and implement strategic partnerships with a wide range of organizations to expand and enhance capabilities to support the Medicaid business and long-range Growth... plan. Will apply knowledge about the unique needs of specialized service populations (including people with intellectual and developmental disabilities, children in foster care, people with serious mental illness or other disabili... 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 firm’s Special Investigations Unit. Will be 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 m... 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
Duties: Assists and interacts with Legal Services Department legal counsel, leadership, retained legal counsel, and outside legal counsel on all aspects of legal matters handled by the Legal Services Department. Reports to Chief Legal Counsel and performs other duties and assignments as requested.... 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 - Healthcare Privacy The candidate should have a . degree from an ABA accredited law school. Current license to practice law is required. Must have 8-10 years of experience in the area of healthcare privacy law. Substantial background in state and federal privacy laws, including HIPAA Privacy and Security rules required. Certified Information Privacy Professional (CIPP) certification or other comparable privacy professional certification (or will... 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, Program Integrity / Investigations The candidate will provide leadership to the Commercial Special Investigations Unit, Provider Audit and Data Mining teams. Primary duties include: development and implementation of program strategies, goals, deliverables, and overall program execution. Develop and administer a strategy that continually reduces the inappropriate provider payments and optimizes opportunities to drive fraud, waste and abuse savings including identify... 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