- McKesson (Columbus, OH)
- …subject matter experts in litigation, labor and employment, IP, data privacy, security, and healthcare fraud and abuse laws as needed. Qualifications Juris ... Fortune 10 company that touches virtually every aspect of healthcare . We are known for delivering insights, products, and...Stark Law, False Claims Act, CMS regulations, state laws), fraud and abuse , privacy, compliance, and licensure… more
- McKesson's Corporate (Tampa, FL)
- …subject matter experts in litigation, labor and employment, IP, data privacy, security, and healthcare fraud and abuse laws as needed.# # **Qualifications ... Fortune 10 company that touches virtually every aspect of healthcare . We are known for delivering insights, products, and...Stark Law, False Claims Act, CMS regulations, state laws), fraud and abuse , privacy, compliance, and licensure… more
- Vertex Pharmaceuticals (Boston, MA)
- …be responsible for executing compliance-related investigations and supporting the company's global healthcare fraud and abuse assurance program and ... auditing and monitoring.* Demonstrated ability to identify and mitigate risk.* Healthcare fraud and abuse auditing and monitoring experience, with preference… more
- Terrain Pharmaceuticals, LLC. (Reno, NV)
- …Monitor and enforce compliance with False Claims Act provisions and all relevant healthcare fraud and abuse laws applicable to pharmaceutical manufacturers. ... Ensure compliance oversight across all operations involving CMOs, CPOs, 3PLs, and promotional activities, including documentation and risk assessment practices. Prepare Company for regulatory inspections, audits, and investigations, ensuring timely resolution… more
- Kubelt (San Francisco, CA)
- …investigation processes. In this role, you will: Monitor real-time events/transactions flagged for fraud and abuse and manually review them using fraud ... and be owned by everyone. About the team The Fraud and Risk Analytics team is responsible for detecting...comprehensive and inclusive employee benefits for this role including healthcare , dental, vision, 401(k) plan and match, life insurance,… more
- LeMaitre Vascular (Burlington, MA)
- …activities. Responsibilities Commercial contracting Corporate compliance (eg, data privacy, anti-bribery/FCPA, fraud and abuse , healthcare transparency laws) ... Marketing legal support Global subsidiary support Litigation management and employment Securities ('34 Act and Section 16 reporting) Mergers and acquisitions Corporate governance, financing and other general corporate matters Legal Counsel support to… more
- MedImpact Healthcare Systems, Inc. (San Diego, CA)
- …such as drug spend forecasting, insurance plan performance optimization, medication fraud /waste/ abuse detection and prevention, preventive care, and personalized ... with the selected candidate." This position is not eligible for Sponsorship. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!… more
- MedImpact Healthcare Systems, Inc. (San Diego, CA)
- …benefit and network optimization simulations, identification of non-adherence risks), and fraud waste and abuse identification that provide actionable ... to data quality, security, and regulatory compliance in a sensitive healthcare environment (PBM/HIPAA).* Excellent written and verbal communication skills, with the… more
- The Mississippi Bar (Los Angeles, CA)
- …full range of legal issues, including but not limited to Stark/AKS analysis, fraud and abuse , EMTALA, HIPAA, reimbursement issues, contracting, risk management, ... laws including those on privacy, Medicare, Medicaid and other government programs, fraud and abuse , physician self-referral and anti-kickback, and EMTALA.… more
- vercel (San Francisco, CA)
- …code along with the team. Participate in and manage the team's on-call rotation. Reduce abuse , fraud , and other harms on Vercel. About You: You have at least ... detection systems to find bad actors, scaling out our abuse response, or working to keep Vercel's new products...to protect Vercel, our users, and society from harms, fraud , and other risks. What You Will Do: Hold… more
- ASSOCIATION FOR COMMUNITY AFFILIATED PLANS (Washington, DC)
- …discern past practice when necessary Typical Duties Governs of the Health Plan's Fraud , Waste, Abuse (FWA) and Financial Misconduct Program (Program Integrity ... college or university Juris Doctor (JD) Professional Registration/Certification or compliance/ fraud related healthcare credentials, current & active, including… more
- University of the Pacific (Stockton, CA)
- …excluded from participating in federal programs for mandatory exclusions (including for fraud , controlled substances crimes, patient abuse or neglect, or other ... excluded from participating in federal programs for mandatory exclusions (including for fraud , controlled substances crimes, patient abuse or neglect, or other… more
- Cardinal Health (Dublin, OH)
- …to pharmaceutical distribution and services and group purchasing organizations, specifically AKS/ Fraud & Abuse * Identify opportunities for process improvements ... in the interpretation and application of relevant laws including, Antitrust; healthcare laws and regulations, (eg, Stark, Corporate Practice of Medicine,… more
- Onos Health (San Francisco, CA)
- …recommendations to health plan administrators and support robust workflows related to addressing fraud , waste, and abuse Prototyping new features and use cases ... Onos Health's mission is simple but ambitious: ensure every healthcare dollar goes toward delivering the highest quality care....the highest quality care. Today, 30% of total US healthcare spending is wasted due to ineffective care and… more
- Integrated Resources Inc. (Washington, DC)
- …main contact for physicians and plan staff regarding pharmacy program issues. * Support Fraud and Abuse program oversight, communicate suspected fraud , and ... build and maintain strong relationships with key figures to provide best-in-class healthcare to members. - Focus on DTM areas, tracking results, program… more
- Mainstreetwashington (Waterloo, IA)
- …for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud , waste and abuse . Brings any questions or concerns regarding compliance ... earned us recognition as a Top 150 Places to Work in Healthcare 2022-2025 by Becker's Healthcare and among America's Best Employers By State in Iowa, Illinois… more
- Virginia Commonwealth University Health (Richmond, VA)
- …and policy.* Advise on federal and state laws, including but not limited to fraud and abuse (ie, Anti-kickback, Stark, Civil Monetary Penalties Law, False Claims ... Job Statements Collaborate with internal teams to negotiate complex healthcare business transactions that satisfy the organization's business objectives, mitigate… more
- Machinify (Palo Alto, CA)
- …reflect NCCI edits (PTP/MUE), DRG/APC logic, CMS NCD/LCD, plan‑specific rules, and fraud /waste/ abuse patterns. Be the market and regulatory intelligence engine ... Machinify is a leading healthcare intelligence company with expertise across the payment...clear ways to maximize financial outcomes and drive down healthcare costs. Machinify is seeking a Director, New Product… more
- San Francisco Health Plan (San Francisco, CA)
- …Certified in one of three (3) areas: Professional Coder (CPC), Accredited Healthcare Fraud Investigator (AFHI), or Certified Internal Auditor (CIA). A ... the investigation and research of allegations of HIPAA violations, fraud waste and abuse , and other compliance...allegations of HIPAA violations, fraud waste and abuse , and other compliance issues. Monitor regulatory, industry, and… more
- Care New England Health System (Providence, RI)
- …payor agreements; and service agreements. 2. Provides advice on issues involving fraud and abuse , regulatory compliance, hospital and medical licensure, and ... on the review, negotiation and drafting of a wide range of healthcare -related contracts and agreements, ensuring compliance with federal and state healthcare… more
