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...
Title: Associate Professor / Professor, Vice Chair of Research, Department of Emergency Medicine Job Overview: The Department of Emergency Medicine at a reputed firm is seeking an accomplished and visionary leader for the position of Vice Chair of Research. This role will...
Join **Members Only**'s Health Care Practice Group as a Partner or Associate H2: Immediate Opportunities in Multiple Ohio Locations **Members Only**, a national law firm with over 750 attorneys, is seeking experienced Partners and Associates for their...
Title: Asst/Assoc/Full Professor, College of Medicine, Primary Care Physician, Midtown Job Responsibilities: - Diagnose diseases or study medical conditions using a variety of techniques such as gross pathology, histology, cytology, cytopathology, clinical chemistry, immunology, flow cytometry, and molecular biology. - Write detailed reports...
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...