Senior Investigator - Fraud, Waste, and Abuse Job at Robert Half (Los Angeles)

Senior Counsel - Fraud, Waste & Abuse Attorney

This Senior Counsel in-house attorney will provide strategic legal counsel for B...

Location

United States , Deerfield

Salary:

224000.00 - 280000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Juris Doctor (JD) from an accredited law school
admission to practice in relevant jurisdiction, active member in good standing
Strong academic record
Significant experience advising commercial teams in the healthcare/life sciences space on fraud and abuse laws
In-house experience supporting a pharmaceutical and/or medical device company will be highly desireable
Familiarity with regulatory frameworks governing medical devices and pharmaceuticals
Strong understanding of pharmaceutical and/or medical device commercialization
Exceptional oral written communication skills, including drafting skills and presentation capabilities
Excellent interpersonal and conflict resolution skills and ability to work in a highly collaborative, team-oriented environment
Ability to maintain an independent and objective perspective while developing and maintaining a strong partnership with the business and other functions

Job Responsibility

Provide legal guidance on arrangements that implicate referral, purchasing, influence, or reimbursement risk
Counsel the business on fraud and abuse laws, discount safe harbors, value-based arrangements and other commercial and regulatory areas
Develop internal expertise, programs and policies to ensure compliance with fraud and abuse laws
Serve as a legal representative on enterprise and cross-functional teams and projects
Support internal investigations and responses to government inquiries related to fraud and abuse topics
Assist in the auditing of the business and development and execution of remediation strategies
Monitor enforcement trends and other legal, regulatory, and governmental developments on fraud and abuse issues impacting the business
Advise leadership of emerging risks related to innovative contracting and market access models
Direct and manage outside counsel efficiently when needed

What we offer

Medical and dental coverage that start on day one
Insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
Educational assistance programs
Paid holidays
Paid time off ranging from 20 to 35 days based on length of service
Family and medical leaves of absence
Paid parental leave

Fulltime

Senior Counsel - Fraud, Waste & Abuse Attorney

This Senior Counsel in-house attorney will provide strategic legal counsel for B...

Location

United States , Deerfield

Salary:

224000.00 - 280000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

Juris Doctor (JD) from an accredited law school
admission to practice in relevant jurisdiction, active member in good standing
strong academic record
significant experience advising commercial teams in healthcare/life sciences on fraud and abuse laws
familiarity with regulatory frameworks governing medical devices and pharmaceuticals
strong understanding of pharmaceutical and/or medical device commercialization
exceptional oral and written communication skills
excellent interpersonal and conflict resolution skills
ability to work in a collaborative, team-oriented environment
ability to maintain an independent and objective perspective

Job Responsibility

Provide strategic legal counsel for Baxter International
primary focus on compliance with US Fraud, Waste & Abuse laws (False Claims Act, federal Anti-Kickback Statute, Stark Law, related reimbursement and coverage issues, applicable state analogues)
provide practical, business-enabling advice to help reduce risk and help the business understand fraud and abuse laws and develop compliance strategies
FCA/AKS Counseling & Risk Management: provide legal guidance on arrangements that implicate referral, purchasing, influence, or reimbursement risk (GPO, IDN, regional and local agreements with customers
non-commercial arrangements with customers involving an exchange of value
distributor and sales-agent agreements
consulting, speaker, advisory board, and clinical education programs
grants, donations, sponsorships, and charitable contributions
data purchase, market research, and service agreements with HCPs and compliance with Sunshine Act
arrangements with customers when there are complaints about product performance

What we offer

Medical and dental coverage that start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP) with ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP) with employee contributions and company matching
Flexible Spending Accounts
educational assistance programs
time-off benefits: paid holidays, paid time off ranging from 20 to 35 days based on length of service, family and medical leaves of absence, paid parental leave
commuting benefits
Employee Discount Program
Employee Assistance Program (EAP)

Fulltime

Senior Investigator, Special Investigations Unit (Aetna SIU)

We’re building a world of health around every individual — shaping a more connec...

Location

United States

Salary:

46988.00 - 112200.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

3-5 years investigative experience in the area of healthcare fraud, waste and abuse
Experience in in Microsoft Word, Excel, and Outlook products, open source database search tools, social media and internet research
Ability to travel approximately 10% of time for business purposes

Job Responsibility

Conduct high level, complex investigations of known or suspected acts of healthcare fraud, waste and abuse
Conduct Investigations to prevent payment of suspect or fraudulent claims submitted by insured's, providers, claimants, and customers
Research and prepare cases for clinical and legal review
Document all appropriate case activity in case tracking system
Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law
Facilitate the recovery of company and customer money lost as a result of fraud, waste and abuse
Cooperate with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud
Demonstrate high level of knowledge and expertise during interactions with internal and external partners
Provide trial testimony in support of criminal or civil proceedings
Give frequent presentations to internal and external customers regarding ongoing case investigations

What we offer

Medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
bonus, commission or short-term incentive program

Fulltime

Special Investigations Unit Senior Investigator

Conduct high level, complex investigations of known or suspected acts of healthc...

Location

United States

Salary:

46988.00 - 112200.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

3+ years investigative experience in the area of healthcare fraud and abuse matters
Working knowledge of medical coding
CPT, HCPCS, ICD10
Proficiency in Microsoft Office with advanced skills in Excel (must know how to do pivot tables)
Strong analytical and research skills
Proficient in researching information and identifying information resources
Strong verbal and written communication skills
Ability to travel up to 10% (approx. 2-3x per year, depending on business needs)
Bachelor's degree or equivalent experience (3+ years of working health care fraud, waste and abuse investigations)

Job Responsibility

Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business
Researches and prepares cases for clinical and legal review
Documents all appropriate case activity in case tracking system
Facilitates feedback with providers related to clinical findings
Initiates proactive data mining to identify aberrant billing patterns
Makes referrals, both internal and external, in the required timeframe
Facilitates the recovery of company and customer money lost as a result of fraud matters
Provides on the job training to new Investigators and provides guidance for less experienced or skilled Investigators
Assists Investigators in identifying resources and best course of action on investigations
Serves as back up to the Team Leader as necessary

What we offer

Medical, dental, and vision coverage
Paid time off
Retirement savings options
Wellness programs
and other resources based on eligibility

Fulltime

Finance Business Partner – Investments

Exceptional opportunity for a commercially astute, analytically strong professio...

Location

United Kingdom , Cheadle

Salary:

55000.00 - 60000.00 GBP / Year

Platinum Recruitment Group Ltd

Expiration Date

Until further notice

Requirements

Qualified in accounting, moved into a commercial accounting role and operating as a Finance Business Partner ideally within a private equity or joint venture environment understanding the associated demands

Job Responsibility

Lead the creation, review and governance of complex financial models to appraise acquisitions, developments and asset-level strategies
Evaluate opportunities using key performance metrics including IRR, equity multiples, yields, sensitivity and downside analysis
Stress test assumptions relating to costings, cap rates, interest rates and exit scenarios
Support debt funding processes by providing lenders with appropriate financial analysis and coverage information
Lead on investment strategies, management and ensure an astute commercial judgement
Lead meetings, provide insight, influence and clear delivery against investment objectives

What we offer

Exceptional benefits package and enhanced career opportunities

Fulltime

Speech Language Pathologist

Aegis Therapies, one of the nation's leading providers of rehabilitation and wel...

Location

United States , Evans

Salary:

35.00 - 50.00 USD / Hour

Aegis Therapies

Expiration Date

Until further notice

Requirements

Current license as a Speech Language Pathologist or ability to obtain in the state of practice

What we offer

Support, local clinical mentorship, clinical education and unlimited CEUs
Create your own career path: clinically, management, etc.
Flexible schedule, paid time off, plus one paid CEU day
Licensure and professional membership reimbursement
Interdisciplinary collaboration for providing the best patient care
Medical, dental, vision within 30 days or less
National opportunity to transfer while maintaining employment status
Multiple settings nationwide: CCRC, SNF, Independent Living, Assisted Living, Outpatient Clinics, Home Health, Telehealth, Post-Acute
New Grads Welcomed

Fulltime

Senior Strategy and Change Consultant

Made Tech wants to positively impact the country's future by using technology to...

Location

United Kingdom , Bristol; London; Manchester; Swansea

Salary:

55000.00 - 65000.00 GBP / Year

Made Tech

Expiration Date

Until further notice

Requirements

Experience of working in a transformation team to deliver valuable, lasting change
Able to combine an understanding of digital technologies with the ability to manage, interpret and utilise data to make informed decisions, improve efficiency and achieve outcomes and benefits
Working knowledge of best practice change methodologies
Working knowledge of business transformation and strategy frameworks and methodologies
Ability to create compelling visions and maintain roadmaps for change
Familiarity with how change happens in the Public Sector, for example, the GDS Service Manual
Clearly articulates client ambitions, collecting insight, delivering analysis and problem resolution
Ability to collect, evaluate and recommend options for transformation
Ability to identify and amend appropriate frameworks and methodologies to enable a consistent and efficient approach to delivery at all stages of the lifecycle
Willingness to build knowledge of wider Strategy and Design capabilities - business analysis, service design, product management, experience design

Job Responsibility

Supports a Strategy and Change Lead to design and implement change approaches and lead business change activities
Provides advice and support to our teams and our clients, helping to shape design and delivery of transformation initiatives covering a wide range of topics: Cost reduction, Workforce transformation, New operating models, Enterprise agility, Continuous improvement, Customer/user experience strategy, Business change communication & enablement, AI / data transformation
Supporting the creation of business cases and relevant proposals for change
Identifies and classifies stakeholders, ensuring their inclusion in the stakeholder engagement plan, leads engagement through developing communications products
Identifies, qualifies, and updates business readiness criteria across areas of responsibility before implementation
Devises ways to track adoption and reports to senior stakeholders
Familiar with a range of strategy frameworks and can apply them to the client context for the best outcomes
Champions best practices and provides expert advice to team members and the Strategy & Design community
Assesses and understands the impact on stakeholders to enhance their adoption of the change
Identifying new business opportunities and raising them with delivery and account teams, and provides strategy and change responses for bids and proposals

What we offer

30 days Holiday
Flexible Working Hours
Flexible Parental Leave
Remote Working
Paid counselling
Smart Tech scheme
Cycle to work scheme
Individual benefits allowance (Health care cash plan or Pension plan)
Social and wellbeing calendar of events

Fulltime

Med Lab Scientist - Core Lab Casual

At Children's Wisconsin, we believe kids deserve the best. Children's Wisconsin ...

Location

United States of America , Milwaukee

Salary:

Not provided

Children's Wisconsin

Expiration Date

Until further notice

Requirements

Bachelor's degree in medical laboratory science, clinical laboratory sciences or one of the chemical or biological sciences related fields that meets ASCP requirements
MT (Medical Technologist) or MLS (Medical Laboratory Scientist) through the ASCP within 1 year of employment
ASCP technologist specialist certification in specialty field would be accepted in lieu of MT certification
Approximately six to twelve months clinical laboratory experience preferred
Must be able to work independently, meet deadlines, and produce error‑free results
Interpersonal skills to work with patients, patient's families, physicians, hospital, and laboratory staff
Leadership ability to assign and review the work of MLTs, MLAs, students and other laboratory allied health staff

Job Responsibility

Performs testing on biological specimens in hospital and/or specialty clinic laboratory
Collects specimens, analyzes, evaluates, interprets, teaches, and reports test results from a variety of specimens to provide clinical data which aid the physicians in the diagnosis and treatment of patients
Performs Maintenance, QA, QC, Quality management, and other activities that support the daily operational functions of the laboratory
Applies critical thinking and cognitive skills to report timely and accurate laboratory reports
Directs designated employees
Problem solves and troubleshoots in a variety of different circumstances

Parttime

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Senior Investigator - Fraud, Waste, and Abuse

Job Description

Job Responsibility

Requirements

What we offer

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