Job Closed

This listing is no longer active.

CVS Health logo
CVS Health

Bringing our heart to every moment of your health.

Senior Investigator, Aetna SIU (Must reside in Ohio)

TherapistTherapistFull TimeRemoteSeniorTeam 10,001+Since 1963H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

76 days ago

Salary

$47.0K - $91.8K / year

Seniority

Senior

No structured requirement data.

Job Description

Senior Investigator, Aetna SIU (Must reside in Ohio)

CVS Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. 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 or high profile, those that are national in scope, complex cases, or cases involving multiple perpetrators or intricate healthcare fraud schemes. - 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 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 manager as necessary - Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud and abuse matters. - Demonstrates high level of knowledge and expertise during interactions and acts confidently when providing testimony during civil and criminal proceedings - Gives presentations to internal and external customers regarding healthcare fraud matters and Aetna's approach to fighting fraud - Provides input regarding controls for monitoring fraud related issues within the business units Required Qualifications - Must live in the state of Ohio - 4+ years investigative experience in the area of healthcare fraud, waste 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. - The ability to understand and analyze health care claims and coding - Ability to travel up to 10% (approx. 2-3x per year, depending on business needs) Preferred Qualifications - Previous Medicaid/Medicare investigatory experience - Previous Behavioral Health experience - Exercises independent judgement and uses available resources and technology in developing evidence, supporting allegations for fraud and abuse. - Credentials such as certification from the Association of Certified Fraud Examiners (CFE), or an accreditation from the National Health Care Anti-Fraud Association (AHFI) - Knowledge of Aetna's policies and procedures. - Knowledge and understanding of complex clinical issues. - Competent with legal theories. - Strong communication and customer service skills. - Ability to effectively interact with different groups of people at different levels in any situation. Education Bachelor's degree or equivalent experience ( A bachelor's degree, or an associate's degree with an additional four+ years working on health care fraud, waste, and abuse investigations and audits; Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $46,988.00 - $91,800.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 05/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Related Categories

Related Job Pages

More Therapist Jobs

Nurse Practitioner - ADHD Diagnosis and Treatment Department: Clinical Employment Type: Contract Location: US - Remote Compensation: $120.00 / hour Description Who are we, and why should you join us? ADHDAdvisor.org is on a mission to remove the conventional barriers to ADHD diagnosis and treatment and make mental health care more accessible to everyone, no matter where they live. Our telehealth platform—http://receptive.com/—was founded to integrate technology, clinical expertise, and progressive approaches to emotional wellness. What are we looking for? We’re looking for Remote Nurse Practitioners to join our provider network. You can focus on providing clinical expertise while we care for everything else. Nurse Practitioners must be able to diagnose and prescribe independently. Who Should Apply? Nurse practitioners licensed in: - Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawai, Idaho, lowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, Wyoming - DEA License preferred but not required. Stimulants can be provided in certain states - NPs who value flexibility and autonomy. - NPs looking for an easy, all-in-one technology platform for telehealth. - NPs who want to focus 100% on clinical work – not on acquiring clients, billing, support, or operations. (We handle all of that!) What You'll Do - Provide holistic mental healthcare to your patients including diagnostic and medication management. - Develop and implement treatment plans tailored to your patient's needs and follow the best practices and clinical guidelines. - Collaborate with our team of mental health professionals to ensure that your patients receive comprehensive, coordinated care. - Maintain accurate and up-to-date patient records following legal and ethical standards. - Help shape our treatment philosophy and contribute to developing clinical policies and procedures. Requirements - Licensed in at least one of these states: Alaska, Arizona, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, lowa, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, Wyoming. - Must have a Psychiatric-Mental Health Nurse Practitioner (PMHNP) License. - Experience in diagnosing and treating adult ADHD. - A private and professional environment for conducting sessions. - Excellent written communication. - Reliable Internet connection. - Currently residing in the US. - Must have their own private malpractice and liability insurance, or be able to receive one before the start date. Benefits - Flexible schedule: You’re always in control of your schedule and appointment times. - Location: We are fully remote – you can work anywhere in the US. - License reimbursement: We pay for your license in states where we face a high demand. - Minimum bureaucracy: We handle operations and ongoing client support. - Visibility: We regularly work with leading mental health online publications (Forbes, Ver Well Mind, etc.) to feature articles or case studies written by our team members. Hourly Pay: $120 Per 15-Min Diagnosis: $30 Per 30-Min Medication Management: $60 Per 45-Min Diagnosis + Medication Management: $90

United States
$120 / hour

Physician - ADHD Diagnosis and Treatment Department: Clinical Employment Type: Contract Location: US - Remote Compensation: $150.00 - $200.00 / hour Description Who are we, and why should you join us? ADHDAdvisor.org is on a mission to remove the conventional barriers to ADHD diagnosis and treatment and make mental health care more accessible to everyone, no matter where they live. Our telehealth platform—http://receptive.com/—was founded to integrate technology, clinical expertise, and progressive approaches to emotional wellness. What are we looking for? We’re looking for a Remote Physician to join our provider network. You can focus on providing clinical expertise while we take care of everything else. A DEA licesnse is preferred, but not required. Who Should Apply? - Physicians looking for an easy, all-in-one technology platform for telehealth. - Physicians who are experienced in prescribing stimulant and non stimulant medication when necessary and following federal and state laws. - Physicians who want to focus 100% on clinical work – not on acquiring clients, billing, support, or operations. (We handle all of that!) What Will You Do? - Provide holistic mental healthcare to your patients including diagnostic and medication management. - Develop and implement treatment plans tailored to your patient's needs and follow the best practices and clinical guidelines. - Collaborate with our team of mental health professionals to ensure that your patients receive comprehensive, coordinated care. - Maintain accurate and up-to-date patient records following legal and ethical standards. - Help shape our treatment philosophy and contribute to developing clinical policies and procedures. Requirements - Licensed in any of the 50 states. - Active DEA License preferred, but not required. - Experience prescribing medication, preferably on a telehealth platform. - Experience in diagnosing and treating adult ADHD. - A private and professional environment for conducting sessions. - Excellent written communication. - Reliable Internet connection. - Currently residing in the US. Benefits - Flexible schedule: You’re always in control of your schedule and appointment times. - Location: We are fully remote – you can work anywhere in the US. - License reimbursement: We pay for your license in states where we face a high demand. - Minimum bureaucracy: We handle operations and ongoing client support. - Visibility: We regularly work with leading mental health online publications (Forbes, Ver Well Mind, etc.) to feature articles or case studies written by our team members Hourly Pay: $150 Per 15-Min Diagnosis: $37.50 Per 30-Min Medication Management: $75 Per 45-Min Diagnosis + Medication Management: $112.50

Wyoming
$150 - $200 / hour
Ministère des armées. Liberté, égalité, fraternité. logo

Cell Leader GTP

Ministère des armées. Liberté, égalité, fraternité.

Personnes à contacter : dcsca-arcueil.gestionnaire.fct@intradef.gouv.fr stephanie.porcher@intradef.gouv.fr

Therapist76 days ago

Role Description Au sein de l’USID de Paris et sous l'autorité du chef de la section gestion du patrimoine, vous assurerez l’encadrement des personnels composant la cellule. Vous serez le garant technique et domanial du patrimoine soutenu par l’unité. - Surveillance, connaissance et prospective liées au patrimoine. - Assurer le bon avancement des opérations domaniales. - Garantir la disponibilité opérationnelle et technique des ouvrages. - Assurer la satisfaction des usagers. - Analyser et suivre la consommation d’énergie. - Proposer des stratégies de maintenance pour optimiser la gestion énergétique. - Apporter votre expertise à la rédaction des cahiers des charges techniques et administratifs des marchés de maintenance. - Assurer les expertises du patrimoine. - Piloter la gestion technique du patrimoine du territoire géographique couvert par l’USID de Paris. - Élaborer les aides techniques et conseiller les acteurs de la gestion technique du patrimoine. - Proposer des indicateurs de performances et des critères de choix dans la passation des marchés de maintenance. Qualifications - Diplôme d’ingénieur ou Master 2 dans l’un des domaines du BTP ou de la gestion immobilière. - Organisé, méthodique et rigoureux. - Capacité à travailler en équipe. Éléments de candidature - Envoi du CV et d'une lettre de motivation est obligatoire. Personnes à contacter - sid-ile-de-france.recrutement.fct@intradef.gouv.fr - arnaud.briere@intradef.gouv.fr

France
Job Closed
Full TimeRemoteTeam 10,001+Since 1949H1B Sponsor

We anticipate the application window for this opening will close on - 7 Apr 2026 At Medtronic you can begin a life-long career of exploration and innovation, while helping champion healthcare access and equity for all. You’ll lead with purpose, breaking down barriers to innovation in a more connected, compassionate world. A Day in the Life We are seeking a committed professional to join our team. While this is a remote position not located at a physical Medtronic site, the candidate hired will be required to reside within the territory and drive to multiple accounts throughout the region. A valid driver's license is essential for this role.Bring your talents to a leader in medical technology and healthcare solutions.  Rooted in our long history of mission-driven innovation, our medical technologies open doors. We support your growth with the training, mentorship, and guidance you need to own your future success. Join us for a career that changes lives.   CAREERS THAT CHANGE LIVES - POSITION DESCRIPTION: The CoreValve Therapy Development Specialist provides technical, clinical, educational and sales support to ensure safe adoption and growth of the Medtronic CoreValve System and future catheter-based therapy technologies.  The CoreValve Therapy Development Specialist works closely with implanting teams and the Medtronic Catheter-based Therapies (CBT) and CVG field organizations to drive procedural and practice success.     - Technical and Clinical Support - Provide clinical expertise for TAVR implanting centers, including “scrubbing in” for TAVI implant procedures to assist with loading valves onto delivery catheter, and providing technical support in accordance with the instructions for use/trial protocol, and best-practices to facilitate procedural consistency and best clinical outcomes - Educational Support - Provide support for site performance and to facilitate safe growth.  Assist in education and training activities with physicians, hospital support staff and Medtronic personnel.  Stay abreast of and communicate clinical data regarding Medtronic products and TAVR therapy - Sales Support - Post approval, collaborate and strategize with territory sales representative and CVG field organization in achieving sales targets and implementing business plans     A DAY IN THE LIFE - POSITION RESPONSIBILITIES: The following responsibilities are to be performed as appropriate in clinical trial case support and/or  case support following commercial approval, depending upon the approval status of the product at the time.    - Technical and Clinical Support - Provide quality technical support to help sites achieve procedural success - Provide technical support to Medtronic employees and implanting teams for CoreValve implant procedures in accordance with Medtronic guidance - Provide technical leadership for TAVR device procedures.  Educate implanting teams on proper indications for TAVR procedures.  Provide support on questions regarding device suitability with measuring ability and CT reconstruction expertise.  Provide comprehensive technical support including knowledge of imaging modalities (echo/angiography/CT), EKG, blood pressure, wave forms, and ancillary procedural solutions - Knowledge of Clinical trial protocols, and CoreValve and other Medtronic TAVR product IFUs for safe and effective use of devices - Develop and maintain comprehensive clinical and technical product knowledge.  Understands current published TAVR and relevant literature.  Recognize and understand competitive products, industry trends, and CBT/CVG portfolio.  Liaison with R&D for technology improvements and next generation needs - Educational Support - Oversee local education and training activities including coordination and set up procedure simulators, facilitation of simulated TAVI procedures and procedural troubleshooting, and coordination and facilitation of staff in-services to include pre/peri/post TAVI procedure - Provide education on safe and effective use of Medtronic products - Educate/train hospital staff with proper valve loading instruction - Customer Service and Sales Support - Support district sales strategy working with sales representatives and managers to achieve business plans within CBT business unit and broader CVG organization.   Contribute to the development of a strong team effort - Ensure comprehensive technical and customer support within territory to maintain superior customer service levels and effective time management - Assist with customer management of inventory ordering, shelf stock, and returns - Identify, establish and maintain productive working relationships with key decision makers, customers and their staff, administrative staff, etc. - Participates in customer/society education meetings and conventions - Respond to customer requests and resolve complaints in a prompt and effective manner - Report and device complaints to proper departments within quality assurance within Medtronic - Help drive and maintain quality initiatives and global best practice initiatives - Maintain high standards of personal presentation and promote a professional personal and company image - Professional Development - Assist in training new hires to Medtronic CBT team.  - Administrative Responsibilities - Submit accurate and timely expense reports - Schedule travel arrangements to ensure multiple objectives are accomplished - Maintain hospital eligibility/access with various vendor credentialing services - Communication - Maintains a high level of communication with appropriate CVG sales and leadership within assigned geography - Communicate market intelligence/competitor activity promptly, including potential sales leads, and information regarding product price or account activity to District Manager and other appropriate company personnel - Ensure a professional standard of written and verbal communication at all times       Qualifications - External MUST HAVE - BASIC QUALIFICATIONS: IN ORDER TO BE CONSIDERED FOR THIS POSITION, THE FOLLOWING BASIC QUALIFICATIONS MUST BE EVIDENT ON YOUR RESUME - High School Degree and 8 years’ experience in a clinical or sales healthcare environment; selling or supporting interventional cardiology, vascular or surgical products OR - Associate degree and 6 years’ experience in a clinical or sales healthcare environment; selling or supporting interventional cardiology, vascular or surgical products OR - Bachelor’s degree and 4 years’ experience in a clinical or sales healthcare environment; selling or supporting interventional cardiology, vascular or surgical products                           NICE TO HAVE - DESIRED/PREFERRED QUALIFICATIONS: - Echocardiology background highly preferred - Associate’s Degree in engineering, nursing, or the sciences - Bachelor’s Degree in Business or Science - Experience with wires, balloons, catheters, stents) - Exceptional understanding of cardiac and vascular anatomy, physiology, and pathology - Experience communicating product’s market advantages to physicians and hospital administration - Experience managing multiple accounts - Experience teaching and educating medical personnel, peers and technical support personnel - Imaging interpretation experience (TTE or Trans Esophageal Echocardiography (TEE), CT, Angiograms) - Expertise with Microsoft Outlook, Excel, Word and PowerPoint - Excellent influencing and consulting skills - Excellent interpersonal and written communication skills - Ability to make timely and sound decisions - Strong project management skills with experience coordinating programs - Thorough working knowledge of medical terminology, medical procedures and the medical device industry - Excellent customer service skills - Effectively build and maintain positive relationships with peers and colleagues across organizational levels and functions - Ability to coordinate/participate in numerous tasks/projects in a fast-paced environment in an organized manner while meeting deadlines - Excellent interpersonal, written and verbal communication skills - Strong work ethic in accomplishing objectives of the position - If the final candidate has an Associate's degree and 8 + OR Bachelor’s degree and 7+ years clinical or sales experience in an industry setting; selling or supporting interventional cardiology, vascular or surgical products they can be considered at the Principal TDS level     PHYSICAL JOB REQUIREMENTS: - The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions - While performing the duties of this job, the employee is regularly required to be independently mobile.  The employee is also required to interact with a computer, and communicate with peers and co-workers - Able to lift 20 pounds - Extended periods of time doing computer-based work - Hearing, sight and speaking ability - Ability to use computers and CT reconstruction programing - Ability to travel extensively by car and plane. Must have valid driver’s license for state of residency and active vehicle insurance policy - Wear lead apron for long periods of time (2-3hrs on average) - Ability to operate a moving vehicle - Ability to work in Cath Labs or OR’s with radiation exposure - Ability to travel with overnight stay up to 50- 75% of the time (geography variability) - Ability to conduct company business outside of the typical Monday through Friday, 8:00am to 5:00pm, work-schedule - Must have a valid driver's license and active vehicle insurance policy.  In addition, your driving record will be reviewed and will be considered as part of your application     ENVIRONMENTAL EXPOSURES: - Infectious disease; radiation; blood borne pathogens - Must be able to wear all required personal protective equipment (PPE) For Baccalaureate degrees earned outside of the United States, a degree that satisfies the requirements of 8 C.F.R. § 214.2(h)(4)(iii)(A) is required. Physical Job Requirements The above statements are intended to describe the general nature and level of work being performed by employees assigned to this position, but they are not an exhaustive list of all the required responsibilities and skills of this position.  The physical demands described within the Responsibilities section of this job description are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. For Office Roles: While performing the duties of this job, the employee is regularly required to be independently mobile. The employee is also required to interact with a computer, and communicate with peers and co-workers. Contact your manager or local HR to understand the Work Conditions and Physical requirements that may be specific to each role. U.S. Work Authorization & Sponsorship At Medtronic, we are committed to fostering an environment where employees can thrive and make a meaningful impact. In alignment with our enterprise-wide workforce planning approach, U.S. work authorization sponsorship (H-1B, TN, J, etc.) is offered exclusively for Principal-level roles and above, where specialized expertise aligns with long-term business needs. Roles below the Principal level require candidates to possess unrestricted U.S. work authorization at the time of hire and for the duration of employment. Join us in our mission to alleviate pain, restore health, and extend life—where your unique background and perspective are valued. Benefits & Compensation Medtronic offers a competitive Salary and flexible Benefits Package A commitment to our employees lives at the core of our values. We recognize their contributions. They share in the success they help to create. We offer a wide range of benefits, resources, and competitive compensation plans designed to support you at every career and life stage. Salary ranges for U.S (excl. PR) locations (USD):$128000 - $140000 In addition to Base Salary, this position is eligible for a Sales Incentive Plan (SIP), which provides the opportunity to earn significant incentive compensation for achieving or exceeding your goals. The following benefits and additional compensation are available to those regular employees who work 20+ hours per week: Health, Dental and vision insurance, Health Savings Account, Healthcare Flexible Spending Account, Life insurance, Long-term disability leave, Dependent daycare spending account, Tuition assistance/reimbursement, and Simple Steps (global well-being program). The following benefits and additional compensation are available to all regular employees: Incentive plans, 401(k) plan plus employer contribution and match, Short-term disability, Paid time off, Paid holidays, Employee Stock Purchase Plan, Employee Assistance Program, Non-qualified Retirement Plan Supplement (subject to IRS earning minimums), and Capital Accumulation Plan (available to Vice Presidents and above, or subject to IRS earning minimums). Regular employees are those who are not temporary, such as interns. Temporary employees are eligible for paid sick time, as required under applicable state law, and the Employee Stock Purchase Plan. Please note some of the above benefits may not apply to workers in Puerto Rico. Further details are available at the link below: Medtronic benefits and compensation plans About Medtronic We lead global healthcare technology and boldly attack the most challenging health problems facing humanity by searching out and finding solutions. Our Mission — to alleviate pain, restore health, and extend life — unites a global team of 95,000+ passionate people. We are engineers at heart— putting ambitious ideas to work to generate real solutions for real people. From the R&D lab, to the factory floor, to the conference room, every one of us experiments, creates, builds, improves and solves. We have the talent, diverse perspectives, and guts to engineer the extraordinary. Learn more about our business, mission, and our commitment to diversity here. It is the policy of Medtronic to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Medtronic will provide reasonable accommodations for qualified individuals with disabilities. If you are applying to perform work for Medtronic, Inc. (“Medtronic”) in any position which will involve performing at least two (2) hours of work on average each week within the unincorporated areas of Los Angeles County, you can find here a list of all material job duties of the specific job position which Medtronic reasonably believes that criminal history may have a direct, adverse and negative relationship potentially resulting in the withdrawal of a conditional offer of employment. Medtronic will consider for employment qualified job applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

United States
$128K - $140K / year
Job Closed