- 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
- Northwell Health (Lake Success, NY)
- …response, ensuring safety and support at all hours + Uphold agency compliance, prevent healthcare fraud , and ensure adherence to all federal, state, and local ... Clinical Director to lead our clients dedicated clinical services team at their innovative outpatient program... clinical services team at their innovative outpatient program in Copiague, NY. This is your opportunity to… 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
- CVS Health (Richmond, VA)
- …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
- Emory Healthcare/Emory University (Atlanta, GA)
- …years progressive experience leading transformation, innovation, or strategic initiatives in healthcare + 5+ years hands-on program /project management experience ... excellence of our academic community. **Description** **Architect the Future of Healthcare Delivery** Emory Health Plan seeks a visionary transformation leader to… 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)
- **Job Description** The senior healthcare auditor is responsible for the completion of internal audits within the clinical integrated parts of the University of ... primary care clinics, and an air medical transport. Senior healthcare auditors are also expected to be familiar or...assessments. . Provides department training on internal controls and fraud prevention and common audit issues. . Provides advisory… 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
- Magellan Health Services (Boise, ID)
- …of experience in fraud investigations, related behavioral or medical healthcare insurance experience in claims, clinical , auditing, compliance, provider ... Certifications - Required License and Certifications - Preferred AHFI - Accredited Healthcare Fraud Investigator - EnterpriseEnterprise, CFE - Certified Fraud… more