- Novo Nordisk Inc. (Plainsboro, NJ)
- …supporting various company initiatives and functions such as Marketing, IT, Clinical , Research, Operations, Patient Support Programs, and Digital Health Lead cross ... of laws and regulations governing the pharmaceutical industry, such as fraud and abuse, government contracting, privacy, advertising and promotion, and scientific… more
- State of Georgia (Fulton County, GA)
- Healthcare Program Clinical Fraud , Waste, and Abuse Consultant 3 (00151424) Georgia - Fulton - Atlanta ... and across the state. DCH is currently seeking qualified applicants for a Healthcare Program Clinical Fraud , Waste, and Abuse Consultant 3 position… more
- Humana (Oklahoma City, OK)
- …**Required Qualifications** + **Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of healthcare ... and will oversee the monitoring and enforcement of the fraud , waste, and abuse (FWA) compliance program ...+ Bachelor's degree or higher + Any applicable certifications ( Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of… more
- New York State Civil Service (New York, NY)
- …detectives, data analysts, and legal support analysts, to conduct complex, long-term healthcare fraud and patient abuse and neglect investigations. The Medicaid ... ensuring the financial integrity of New York state's $96 billion Medicaid program by investigating healthcare providers, such as pharmaceutical companies,… more
- CVS Health (Phoenix, AZ)
- …Managers, and Directors as appropriate in matters pertaining to the investigation of suspected healthcare fraud cases Completion of Fraud waste and abuse ... is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources. Under the direction… more
- RELX INC (Concord, NH)
- …science and research, health education and interactive learning, as well as exceptional healthcare and clinical practice. At Elsevier, your work contributes to ... you love identifying business opportunities with hospitals, health systems, and healthcare providers with enterprise information solutions? Do you excel in… more
- CVS Health (Baton Rouge, LA)
- …system that is transparent, consumer-focused, and acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting ... Medicaid, this role is responsible for utilization, quality, and fraud , waste, and abuse reviews for individual cases involving...daily support and guidance to the ABA prior authorization clinical team and health plan medical directors. * Attend… more
- RELX INC (Trenton, NJ)
- Customer Success Manager I, Clinical Solutions Do you have experience with operational customer support and implementing or supporting software solutions? Do you ... a key role in ensuring satisfaction, retention, and growth across Elsevier's Clinical Solutions portfolio. As a trusted partner, the CSM leads post-implementation… more
- University of Washington (Seattle, WA)
- …diversity, intellectual excitement, artistic pursuits, and natural beauty. The senior healthcare auditor is responsible for the completion of internal audits within ... the clinical integrated parts of the University of Washington/UW Medicine...primary care clinics, and an air medical transport. Senior healthcare auditors are also expected to be familiar or… more
- Genesis Healthcare (PA)
- …Moreover, this position will be key in assisting with the LTC ACO HCC program ensuring that claims are coded and documented accurately and completely, helping to ... + Assist in the development of a comprehensive training program to all new providers with a focus on... to all new providers with a focus on clinical documentation that supports and matches accurate and complete… more
- CVS Health (Columbus, OH)
- …you will conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high ... complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent...lines of business + Researches and prepares cases for clinical and legal review + Documents all appropriate case… more
- RELX INC (New York, NY)
- …science and research, health education and interactive learning, as well as exceptional healthcare and clinical practice. At Elsevier, your work contributes to ... escalation frameworks Requirements: + 5+ years in project or program management in B2B marketing, GTM, or transformation roles...health education and interactive learning, as well as exceptional healthcare and clinical practice. What you do… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …treat. Otsuka's Clinical & Scientific Liaison (CSL) will provide deep clinical expertise on-demand and will engage healthcare providers to offer personalized ... on patient, caregiver, and HCP needs in an evolving healthcare environment. The new model is built around where...at the local ecosystem level. + Assist with Otsuka's clinical trials program , including registrational, post-marketing and… more
- UnityPoint Health (Waterloo, IA)
- …the calendar year + Maintains knowledge of compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and ... successful clinical business leadership. Knowledgeable and continually mindful of healthcare trends, opportunities, challenges and healthcare policy and the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines ... substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and… more
- RELX INC (Philadelphia, PA)
- …science and research, health education and interactive learning, as well as exceptional healthcare and clinical practice. At Elsevier, your work contributes to ... with advanced technology capabilities, we deliver intelligent guidance that strengthens clinical decision making and patient outcomes. Recognized by leading … more
- Atlantic Health System (Morristown, NJ)
- …accountable care organization compliance; (v) Medicare C & D/Medicare Advantage compliance program requirements; (vi) Federal healthcare program compliance; ... part, the following compliance risk areas: (i) general compliance and compliance program effectiveness; (ii) fraud , waste and abuse and Deficit Reduction… more
- Point32Health (Canton, MA)
- …health and well-being organization dedicated to delivering high-quality, affordable healthcare . Serving nearly 2 million members, Point32Health builds on the ... behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of… more
- Option Care Health (Bannockburn, IL)
- …in Healthcare Compliance (CHC), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or similar certification preferred. + Direct experience in home ... patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the… more
- UnityPoint Health (Anamosa, IA)
- …Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste ... + Job ID: 170618 Overview Assist provider and other clinical staff with obtaining basic vital information preparing patient...recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in… more
