- Humana (Pierre, SD)
- …a part of our caring community and help us put health first** The Manager , Fraud and Waste conducts investigations of allegations of fraudulent and abusive ... practices. The Manager , Fraud and Waste works within specific...website. **WAH Internet Statement** To ensure Home or Hybrid Home/ Office employees' ability to work effectively, the self-provided internet… more
- Point32Health (Canton, MA)
- …we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Senior Manager , Compliance Program will manage the day-to-day operations of the ... projects, and personnel necessary to ensure compliance with Medicare, Commercial and Medicaid laws and regulations and governing contracts with the Centers for… more
- State of Colorado (Denver, CO)
- …UHA01644_12.2025 Department Department of Health Care Policy and Financing Division Medicaid Operations Office Opening Date 12/05/2025 Closing Date 12/26/2025 ... application materials are received by the appropriate Human Resources office before the closing date and time listed. +...for a Third Party Liability & Cost Avoidance Section Manager to join our Fraud , Waste &… more
- MyFlorida (Pensacola, FL)
- …position is in the Office of the Attorney General within the Medicaid Fraud Control Unit in Pensacola, Florida. Pay:$60,000.20 - $62,425.00 Annually ... be given to candidates with healthcare fraud investigative experience working in a Medicaid Fraud Control Unit, or five (5) years of sworn law enforcement… more
- State of Colorado (Pueblo, CO)
- Nurse Manager - Mid Level Provider - CMHHIP Nursing- Pueblo Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5171266) Apply Nurse Manager - ... application materials are received by the appropriate Human Resources office before the closing date and time listed. +...as indicated in this announcement and if the hiring manager chooses to extend a job offer to you,… more
- Bausch + Lomb (Atlanta, GA)
- …opportunity to join our dry eye Market Access team. The **Field Access Manager ** is a field-based non-promotional position who will use their extensive knowledge of ... to provide an excellent customer experience. **Responsibilities** + Work directly with office support staff, third party vendors (ex. HUBs), and other important… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Financial Compliance Audit, $10,000 SIGN ON BONUS Job Category: Accounting/Finance Department: Financial Compliance Location: Los Angeles, CA, US, 90017 ... and to support the safety net required to achieve that purpose. Job Summary Manager , Financial Compliance Audit (Finance) has a $10,000 SIGN-ON BONUS. This role is… more
- Martin's Point Health Care (Portland, ME)
- …certified as a "Great Place to Work" since 2015. Position Summary The Manager of Payment Integrity is responsible for developing, implementing, and managing programs ... leading recovery efforts while improving system controls and operational efficiency. The manager partners closely with internal teams and external PI vendors to… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …recovery amounts and processes incoming payments. + Provides support to the Medicaid Fraud and Recovery Investigative Unit's ongoing, statewide operational ... activities relative to restitution and fraud recoveries. + Pursues the recovery of funds from...system. + May serve as backup to management (ie Medicaid Program Supervisor, Medicaid Program Manager… more
- Grant Thornton (Atlanta, GA)
- As a Process Risk Experienced Manager , you will have the opportunity to grow and contribute to our clients' success by helping them identify and understand their ... for business and IT process optimization, profit improvement, cost reduction, fraud prevention, internal control, and compliance. + Perform engagement management… more
- Louisiana Department of State Civil Service (LA)
- …Team, and the Insurance Fraud Unit. The Criminal Division also serves: + Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud Control ... Statewide, LA Job Type Unclassified Job Number AG(11.17.2025)LE4 Department DOJ- Office of the Attorney General Opening Date 11/17/2025 +...+ Criminal + Federalism + Gaming + Litigation + Medicaid Fraud Control + Public Protection +… more
- Molina Healthcare (Covington, KY)
- **JOB DESCRIPTION** **Job Summary** Under direct supervision of the Manager , SIU, the Team Lead is responsible to lead a small team of investigators and provide ... oversight on daily investigative activities as a back-up to the SIU Manager . This position will be accountable for tracking on investigations conducted by his/her… more
- Louisiana Department of State Civil Service (LA)
- …and provides investigative services in cybercrimes, white collar crimes, and public corruption. Medicaid Fraud Control Unit: The Louisiana Medicaid Fraud ... Location Statewide, LA Job Type Unclassified Job Number AG(11/17/2025)LE6 Department DOJ- Office of the Attorney General Opening Date 11/17/2025 + Description +… more
- CVS Health (Columbus, OH)
- …conduct high level, complex investigations of known or suspected acts of healthcare fraud and abuse. Routinely handles cases that are sensitive or high profile, ... complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes. + Investigates to prevent payment of fraudulent claims submitted… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services (CMS). Provides routine interaction and coordination with the BCBS Association National Anti- Fraud office , BC/BS Plan SIUs, FEP, CMS, DOH, OMIG, MFCU, ... for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines of...Recommends providers for referrals to the New York State Office of Professional Medical Conduct Office of… more
- Covenant Health Inc. (Knoxville, TN)
- …to maintain a proper compliance stance + Under the direction of Revenue Integrity Manager works with the Chief Compliance Office relative to coding, billing and ... Performs other duties as needed. Reports to the Revenue Integrity Manager . Recruiter: Suzie McGuinn || ###@covhlth.com Responsibilities Integrity + Identifies and… more
- Covenant Health Inc. (Knoxville, TN)
- …Responsible for education and training for all Covenant coders, CDI, and/or physician office staff. Serves as a resource to coders, CDI staff, Quality and Case ... Managers, Decision Support and physician office personnel regarding coding questions. Responsible for educating coders, CDI staff, and assisting with physician… more
- Option Care Health (Bannockburn, IL)
- …summarize and communicate complex findings effectively. Reporting to the Senior Manager , Compliance Auditing, Monitoring and Analytics, this individual assists in ... risk areas such as regulatory changes, billing and coding, privacy and security, and fraud and abuse. + Perform data analysis and review of documentation to identify… more
- Centene Corporation (Frankfort, KY)
- …as a subject matter expert for the Contractor's Program Integrity unit to reduce Fraud , Waste and Abuse of Medicaid services within Kentucky. Provides direction ... and guidance to staff who investigate and remediate compliance and fraud , waste, and abuse related matters; while maintaining an investigative workload of moderate… more
- State of Minnesota (St. Paul, MN)
- …+ **Hiring Agency/Seniority Unit** : Human Services Dept / MAPE DHS Central Office + **Division/Unit** : Health Care Administration / Integrity and Accountability - ... Insurance Integrity and Accountability Division exists to assure that Medicaid is the payor of last resort in those...and recovery deadlines. + Assists the unit supervisor, section manager , staff attorney, and division director with research and… more