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include the following. Other duties may be assigned Utilizes leads provided by the team and referrals from government and private agencies, works with the team to prioritize complaints for investigation, and then investigates, conducts interviews and reviews information to make potential fraud determination. Determines investigation or case appropriateness of fraud, waste and abuse issues in accor
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The Business Process Engineer performs management and support of the analysis, design, development, and implementation of diverse, enterprise wide healthcare processes and application systems. Tasks may include the design study process; conducting studies in support of system redesign and business process reengineering, improvement and management; developing implementation plans; and supporting th
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While medical review and support of review determinations are the primary responsibilities, this position also includes the following essential duties and responsibilities. Other duties may be assigned. Provides clinical information to teams Medical Review responsibilities may include Physician peer reviews Supporting determinations during appeal process, including depositions and other testimony
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While medical review and support of review determinations are the primary responsibilities, this position also includes the following essential duties and responsibilities. Other duties may be assigned. Provides clinical information to teams Medical Review responsibilities may include Physician peer reviews Supporting determinations during appeal process, including depositions and other testimony
Posted Today
While medical review and support of review determinations are the primary responsibilities, this position also includes the following essential duties and responsibilities. Other duties may be assigned. Provides clinical information to teams Medical Review responsibilities may include Physician peer reviews Supporting determinations during appeal process, including depositions and other testimony
Posted Today
Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations. Design data analysis strategies to identify potential areas for quality improvement or focused investigation. Develop epidemiological sound indicators of the quality of care. Analyst data and summarize into quality indicator values Iden
Posted Today
Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations. Design data analysis strategies to identify potential areas for quality improvement or focused investigation. Develop epidemiological sound indicators of the quality of care. Analyst data and summarize into quality indicator values Iden
Posted Today
Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations. Design data analysis strategies to identify potential areas for quality improvement or focused investigation. Develop epidemiological sound indicators of the quality of care. Analyst data and summarize into quality indicator values Iden
Posted Today
Trend data to identify potential opportunities (e.g., variances, significant outliers, percentile ranked groups) for quality improvement or focused investigations. Design data analysis strategies to identify potential areas for quality improvement or focused investigation. Develop epidemiological sound indicators of the quality of care. Analyst data and summarize into quality indicator values Iden
Posted Today
Data Analyst Healthcare Job Location Dallas, TX Position Type Full Time/Regular Qlarant, Inc., is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We're a national leader in fighting fraud, waste and abuse for large organizations across the country. As a Data Analyst working o
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Administrative/Clerical Support Job Location Dallas, TX Position Type Full Time/Regular Qlarant is a not for profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, an
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