- Humana (Richmond, VA)
- …driving health outcomes and cost-effective care for our members. We are seeking a Clinical Investigation Lead to provide strategic direction to drive ... owners across Humana to drive solutions forward. In this role you will lead quantitative and qualitative investigations to identify actionable insights and bring… more
- HCA Healthcare (Richmond, VA)
- …manage and analyze close calls and adverse patient events, conduct educational programs, lead clinical initiatives, and comply with regulatory standards. + In ... In this role you will mentor and support our clinical team members to protect patients from harm and...(Root Cause Analysis), FMEA (Failure Mode and Event Analysis), lead investigations for serious adverse events, and… more
- Elevance Health (Richmond, VA)
- …prior to payment. Researches new healthcare-related questions as necessary to aid in investigations . + Collaborates with the Special Investigation Unit and other ... evaluation of the collected data. + Performs in-depth investigations on identified providers as warranted. + Examines claims...experience, including minimum of 1 year experience in a Clinical Fraud and Abuse Investigation area; or… more
- Elevance Health (Richmond, VA)
- ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** _Location: This position will work a hybrid model (remote and office). The ideal ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying issues and/or… more
- HCA Healthcare (Richmond, VA)
- …+ Work with leaders to submit and approve exceptions to IPS standards. + Lead audit response activities to address IPS issues identified by Internal Audit or ... and Resolution + Support, coordinate, and manage incident response and investigation activities. + Investigate information leaving the organization with appropriate… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …and exercising professional judgment in initiating and implementing administrative and clinical decisions are integral components of the position.The Richmond VA ... of care, and a Parkinson's Disease Research, Education and Clinical Center (PADRECC), one of six in the nation.VA...from employees, Veterans, families and others as they present. Lead a team comprised of clinicians, technicians, and administrative… more
- Omnicell (Richmond, VA)
- …at the top of your license, contribute to a community's well-being, and lead the pharmacy team. With autonomy, you'll drive efficient, effective, and continually ... as Autoimmune, Oncology, Hepatitis C, HIV, and more + Clinical oversight and industry innovation; committee member participation as...improve. + In **Doing the Right Thing** , we lead by example in ALL we do. We are… more
- Takeda Pharmaceuticals (Richmond, VA)
- …identifying, evaluating, and screening qualified research sites for company sponsored clinical investigation + Actively participates in executing USMAO strategy ... molecular pathways, mechanism of action Takeda Oncology products including clinical outcomes and research opportunities. + Formulate and keep...at medical conferences and may "co- lead " a medical conference to inform for being a… more
- Elevance Health (Bon Air, VA)
- …& Appeals** will be responsible for management oversight of receipt, investigation and processing associated with provider disputes ensuring regulatory compliance, ... of claims, provider contracts and data, eligibility, member contracts, benefits, clinical decisions, pharmacy on pre-service and post service appeals and grievances… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …appropriateness before performing exams. Incumbent uses appropriateness criteria, the clinical history-provided on the request, interviews the patient, reviews the ... required to serve a probationary period. Subject to background/security investigation . Selected applicants will be required to complete an...have the ability to stand and work while wearing lead apron for long periods of time. How applicants… more