- Elevance Health (Seattle, WA)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually ... is determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying… more
- Humana (Oklahoma City, OK)
- …and help us put health first** Humana's Special Investigations Unit is seeking a Senior Fraud & Waste Investigator to join the Oklahoma Medicaid Team. This team ... Humana's Oklahoma Medicaid line of business. As the Senior Fraud and Waste Investigator , you will serve...+ Bachelor's degree or higher + Any applicable certifications ( Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of… more
- Humana (Lincoln, NE)
- …part of our caring community and help us put health first** The Fraud and Waste Professional 2 is responsible for conducting comprehensive investigations of ... reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud ...+ Bachelor's degree or equivalent work experience + Strong clinical experience to include multiple practice areas + At… more
- MVP Health Care (Tarrytown, NY)
- …innovative thinking and continuous improvement. To achieve this, we're looking for a ** Clinical Investigator ** to join #TeamMVP. This is the opportunity for you ... professional investigation experience involving economic or insurance related matters. + A clinical investigator must have in addition to the above requirements:… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of the SIU Management, this position is responsible for the accurate and thorough clinical investigation of potential fraud , waste and abuse (FWA) for all lines ... substantiating referrals, case planning and research, conducting onsite or desk audits, clinical reviews of medical records to ensure correct billing of services and… more
- AmeriHealth Caritas (Columbia, SC)
- …services. Discover more about us at www.amerihealthcaritas.com. The Investigator is responsible for conducting comprehensive investigations of reported, ... alleged or suspected fraud involving the full range of products at the...lieu of formal educational requirements for the Lead SIU Investigator position may be considered. + Valid driver's license… more
- CVS Health (Columbus, OH)
- …it all with heart, each and every day. **Position Summary** As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts ... of healthcare fraud and abuse. Routinely handles cases that are sensitive...lines of business + Researches and prepares cases for clinical and legal review + Documents all appropriate case… more
- Point32Health (Canton, MA)
- …about who we are at Point32Health (https://www.point32health.org/) . **Job Summary** The Investigator I is an essential team member of the Special Investigation Unit ... ("SIU") responsible for leading complex provider investigations related to fraud , waste, and abuse, and developing action plans to...the direction of the Manager, FWA Prepayment Review. The Investigator I works closely with other members of the… more
- Otsuka America Pharmaceutical Inc. (Annapolis, MD)
- … Clinical Practice (GCP) compliance** across Contract Research Organizations (CROs), clinical laboratories, and clinical investigator sites. This role ... + **Audit Execution** : Plan, conduct, and report GCP audits of CROs, clinical laboratories, and investigator sites globally, ensuring compliance with ICH-GCP,… more
- Otsuka America Pharmaceutical Inc. (Olympia, WA)
- …The Senior Manager of Global Quality Management (GQM) supports the execution of clinical quality activities to ensure compliance with Good Clinical Practice ... (GCP), regulatory requirements, and internal standards across global clinical trials. This role provides hands-on quality oversight, supports audit and inspection… more
- Otsuka America Pharmaceutical Inc. (Waltham, MA)
- …clinical development plans. + Provide medical leadership for protocols, ICFs, investigator brochures, and core clinical materials; monitor safety and ... Area Head, reporting to the VP, Translational Medicine and Early Clinical Development within OPDC's Early Development Organization (EDO). The Senior Director… more
- Astellas Pharma (Northbrook, IL)
- …services, advisory boards and councils, data sharing and data licensing, investigator -initiated studies, regulatory and quality agreements + Providing legal and ... complex agreements in support of Development, including agreements for clinical trials, assay development, companion diagnostics, expanded access, compassionate use,… more
- Otsuka America Pharmaceutical Inc. (Sacramento, CA)
- …sharing at the local ecosystem level. + Assist with Otsuka's clinical trials program, including registrational, post-marketing and Investigator -Sponsored Trials ... expanded expertise regarding products and the approved conditions they treat. Otsuka's Clinical & Scientific Liaison (CSL) will provide deep clinical expertise… more
- GE HealthCare (Boston, MA)
- …outside counsel (as necessary) * Advise on legal and compliance matters including Good Clinical Practices (GCP), Fraud and Abuse, Foreign Corrupt Practices Act / ... legal counsel to the Global Research and Development teams (including Medical and Clinical Affairs), as well as company business segment and technology teams on… more
- Parsons Corporation (San Antonio, TX)
- …for assisting with the collection of supporting documentation, coordinating clinical research studies, and maintaining regulatory requirements. In addition, the ... IACUC/IRB requirements. + Develop and coordinate the implementation of clinical research studies, including regulatory requirements, maintenance of study records,… more
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