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 Review...
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: 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 Fair...
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 by...
Title: Senior Associate Counsel Job Responsibilities: - Provide comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence within a hospital setting. - Advise hospital leadership and procurement teams on the legal implications of...