- Geisinger (Danville, PA)
- …Responsible for the strategic direction, planning, oversight, and operation of the Special Investigations ("SI") and Program Integrity ("PI") teams. Develops and ... by the enterprise. Job Duties + Provides leadership and strategic direction of Special Investigations and Program Integrity units spanning all lines of business.… more
- Centene Corporation (Jefferson City, MO)
- …workplace flexibility. **Position Purpose** : Drive high quality and compliant investigations through the implementation and management of a robust investigations ... will be responsible for: + Implementing and managing an SIU -wide quality monitoring process + Maintaining tools and resources...field or equivalent. 7+ years of related compliance and/or special investigation experience in managed care or CMS. JD… more
- Elevance Health (Chicago, IL)
- …(Data Mining, Coordination of Benefits, Complex and Clinical Audit, Claims Edits, and the Special Investigations Unit ) operating as an internal consultant to ... **Program Director - Process Improvement** **Location:** This role requires...Operational Excellence organization is looking to hire a **Program Director ** . This Director will partner with… more
- Blue KC (MO)
- …other areas within the company, including but not limited to Sales and Marketing, Special investigations Unit (fraud and abuse), Legal, Product Development, ... assistance** **Employee discount program** **Job Description Summary:** The Lead Medical Director actively uses their clinical training, experience, and judgement to… more
- Blue KC (MO)
- …the company, including but not limited to Sales and Marketing, Job_Family_ID_Underwriting, PHP, Special investigations Unit (fraud and abuse), Legal, Product ... Development, and Provider Services. + Provides medical leadership and advice for conformance with standards and guidelines for NCQA, URAC, state and federal regulators, and other accrediting bodies. + Acts as liaison for communication with physicians,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …agencies (eg APS/CPS) as needed, and any suspected/possible Medicaid fraud to the Special Investigations Unit ( SIU ) or designated internal/external ... as required. + May be required to attend Fair Hearings with Medical Director relating to specific cases. + Works independently, as well as collaboratively, with… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …as a liaison for activity generated by Customer Advocacy (CAU), Customer Service (CS), Special Investigations Unit ( SIU ), Provider Relations (PR), or ... Behavioral Health, Respiratory Therapy, Registered Dietitian, Registered Nurse, Medical Director , Pharmacist, Geriatrics, etc.) to ensure continuity and coordination… more
- Molina Healthcare (Columbus, OH)
- …accountability for compliance by overseeing, follow-up and resolution of investigations . **Knowledge/Skills/Abilities** * Responsible for oversight and management of ... AVP of Compliance or the AVP of the Corporate SIU an active relationship with third parties who have...who have specific experience in conducting fraud and abuse investigations . * Prepares written reports to inform the AVP… more
- State of Massachusetts (Boston, MA)
- …(ie, referral to Special Investigations Unit ). * Participate on special projects assigned by the Director . * Assist the Director with organizing ... Role:_* The Insurance Examiner II position reports to the Director of the Consumer Services Unit , which...basis of the proportion of the requirements actually completed. Special Requirements: Based on assignment, possession of a current… more
- City of New York (New York, NY)
- …strong and healthy neighborhoods anchored by affordable housing. - The Strategic Initiatives Unit ( SIU ) leads special ONS initiatives and provides essential ... ONS is composed of two divisions and a cross-divisional unit reporting to the Associate Commissioner: - The Division...Commissioner of Neighborhood Strategies. Your Impact: Reporting to the Director of Land Use and Policy, the Senior Planner… more
- TD Bank (New York, NY)
- …framework across trade and communications monitoring. The incumbent will report to the Director of Surveillance Quality Assurance and will be part of the broader ... Surveillance Intelligence Unit , comprised of the Surveillance Data Quality Team, Surveillance...Quantitative Analysis Team, and Surveillance Quality Assurance Team. The SIU in turn reports to the Global Head of… more
- City of New York (New York, NY)
- …strong and healthy neighborhoods anchored by affordable housing. - The Strategic Initiatives Unit ( SIU ) leads special ONS initiatives and provides essential ... ONS is composed of two divisions and a cross-divisional unit reporting to the Associate Commissioner: - The Division...livable, and equitable. Your Role: Reporting to the Borough Director , your role will include managing, tracking, reporting, and… more
- City of New York (New York, NY)
- …The advertised position is a member of this division. - The Strategic Initiatives Unit ( SIU ) leads special ONS initiatives and provides essential technical, ... Mayor's Housing Plan. ONS is composed of two divisions and a cross-divisional unit reporting to the Associate Commissioner: - The Division of Planning and… more