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UM Specialist - Work at home - CO, AZ or NM residence prefer...

Make outbound calls to engage members and/or providers to verify clinical information. Document all calls and attach clinical information received....

Fraud and Waste Investigator, Special Investigations Unit -...

Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed....

Fraud and Waste Investigator

Manage a large caseload of pharmacy fraud investigations while making decisions regarding own work methods, occasionally in ambiguous situations, and requires...

Outbound Contacts Representative 2

Saint Petersburg, FL
Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion....

Fraud and Waste Investigator, Commercial

Traditional investigative methodologies will apply to include evidence collection, site surveys, data analysis, and interviews of individuals related to the...

Telephonic Utilization Management Nurse (RN) - Work at home,...

Washington, DC 20004 (Downtown area)
The ideal candidate for this position will live within the Mountain or Pacific Time zones, have an active and unrestricted RN license and a background working...

Corporate Medicaid Implementation Advisor

Louisville, KY 40229
As a representative of the Medicaid Implementation team, provide strategic leadership as we evaluate market entry strategies in pipeline markets and respond to...

Provider Contracting Executive - Work at Home Pennsylvania

Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses...

Process Improvement Professional 2

Master’s degree in related field preferred. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and...

Special Investigations Unit Manager, Fraud and Waste

Position will also require engagement with governing state Medicaid agencies and assistance with Medicaid compliance reporting , which includes understanding...
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