Program Integrity Investigator (Healthcare Fraud Waste & Abuse) TriWest Healthcare AllianceProgram Integrity Investigator (Healthcare Fraud Waste & Abuse)Honolulu, HIRemoteFull timeComplies with the Veterans Affairs Community Care Network (CCN) and TRICARE T-5 contracts; DHA and TRICARE program guidelines and pertinent Federal regulatory requirements; assists supervisors with FWA trending and reporting requirements; coordinates and assists with investigations and prosecutions by federal agencies interfaces directly with Veterans, Military members and family (as warranted), providers, subcontractors, and other TriWest departments on FWA issues; assist supervisor with the education and training of TriWest, subcontractor, and provider personnel on current FWA matters; prepares appropriate responses to provider compliance issues and complaints referred to Program Integrity by other TriWest departments or external referrals. The PI Investigator t is responsible for the identification, analysis, case development, and reporting of suspected fraud, waste and abuse (FWA) cases as defined by the Department of Veterans Affairs (VA), the Healthcare Finance Administration (HCFA) and the Department of Defense, Defense Health Agency for the TRICARE program; requests and reviews issue-related medical claims and records for FWA and/or administrative and clerical error(s).
Category Manager Healthcare Operations Hawaii Medical Service AssociationCategory Manager Healthcare OperationsHonolulu, HIAnalyze health operations vendor spend and utilization trends to identify savings opportunities; deliver and track quantifiable cost savings, cost avoidance, and value creation across health operations spend. Partner with the Chief Procurement Officer (CPO) and operations leadership to develop multi-year category strategies for Healthcare operations vendors.
Commercial & Healthcare Regulatory Counsel Alto IncCommercial & Healthcare Regulatory CounselHIRemote$135,000–$185,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. Issue-spot and provide practical guidance on applicable laws and regulations, such as the Anti-Kickback Statute (AKS), Stark Law, False Claims Act, FDA/DEA requirements relevant to pharmacy and telehealth operations, state pharmacy/professional licensing, PBM contracting/network participation, and HIPAA/HITECH.
Construction Project Manager Capital Projects / Healthcare Facilities Pyramid Consulting, IncConstruction Project Manager Capital Projects / Healthcare FacilitiesHonolulu, HIRemote$60–$65 / hourKey Requirements and Technology Experience: 4+ years of experience in construction project management, capital projects, or facility build-out/renovation projects. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners.
Pediatric Healthcare Programs, Senior Manager American Red Cross Blood ServicesPediatric Healthcare Programs, Senior ManagerHI$96,624–$128,832 / yearAmeriCorps, the federal agency that brings people together through service, and its partners - the Peace Corps, AmeriCorps Alums, National Peace Corps Association, and the Service Year Alliance - launched Employers of National Service to connect national service alumni with opportunities in the workforce. WHAT YOU NEED TO KNOW (Job Overview): Reporting to the Director, Healthcare Programs, the Pediatric Healthcare Programs Senior Manager, will serve as subject matter expert for Pediatric Healthcare and EMS educational programs.
Healthcare Services Analyst I Hawaii Medical Service AssociationHealthcare Services Analyst IHonolulu, HIUse a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews with internal departments including clinical consultants, other Blue Cross/Blue Shield Plans and vendors. New Code Implementation: With the guidance of the Healthcare service analyst II, learns how to load new codes, downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.).
Healthcare Financial/Actuarial Manager Willis Towers Watson PLCHealthcare Financial/Actuarial ManagerHonolulu, HI$90,000–$120,000 / yearWTW provides a competitive benefit package which includes the following (eligibility requirements apply): Health and Welfare Benefits: Medical (including prescription coverage), Dental, Vision, Health Savings Account, Commuter Account, Health Care and Dependent Care Flexible Spending Accounts, Group Accident, Group Critical Illness, Life Insurance, AD&D, Group Legal, Identify Theft Protection, Wellbeing Program and Work/Life Resources (including Employee Assistance Program). You will substantially contribute to a wide variety of complex analyses and projects involving the design, financing, and measurement and financial analysis of the full spectrum of employer health and group benefit programs including medical, dental, life, disability, voluntary benefits, etc.
Strategic Account Executive - Healthcare UKGStrategic Account Executive - HealthcareHonolulu, HI$90,000–$95,000 / yearThis Account Executive will be in a role of focusing on both acute and non-acute care accounts between 1-500 employees; the role requires a hunter focus on existing accounts seeking to add on Payroll, HR, Talent, Benefits, and additional HCM products, as well as expanding their labor management solution with additional products such as absence management, scheduling, and the analytics solutions. This person will be tasked with creating and maintaining key stakeholder relationships, in the accounts, and maximize opportunities to attain and exceed annual sales goals for the territory and the UKG Healthcare sales team.
Healthcare Services Analyst II Hawaii Medical Service AssociationHealthcare Services Analyst IIHonolulu, HINew Code Implementation: Act as lead in loading of new codes by following existing documented process and timeline for downloading, processing and importing new codes (CPT, HCPC, ICD-10, etc.). Drive implementation of changes through writing of Work Intake Form, participation in multi-department meetings, contribution and review of requirements, validation of test cases, and post-implementation monitoring.
Mechanical Engineer - Healthcare Facilities Design - Honolulu, HI Stantec IncMechanical Engineer - Healthcare Facilities Design - Honolulu, HIHonolulu, HIWork collaboratively with project leaders, architects, design partners, peers, contractors, and other project stakeholders to define project objectives, deliverables, and success metrics, and develop innovative and practical solutions, and meet the project''s conditions of satisfaction. In this role, you will apply building mechanical engineering principles, your superior client service skills, and project management best practices to deliver projects that meet project requirements, exceed client expectations, and meet project financial and other objectives.
Construction Project Manager – Capital Projects / Healthcare Facilities Pyramid, IncConstruction Project Manager – Capital Projects / Healthcare FacilitiesHonolulu, HI$60–$65 / hourFull timeKey Requirements and Technology Experience: 4+ years of experience in construction project management, capital projects, or facility build-out/renovation projects. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners.
Case Management Manager AlohaCareCase Management ManagerHonolulu, HI$81,000–$110,000 / yearThe Case Management Manager manages the case management team and the care coordination of behavioral health members to develop and assess high-quality, cost-effective healthcare outcomes related to mental and behavioral health needs. Direct the daily activities of case management staff including reviewing and approving the caseloads of case management staff based on state requirements, case management staff experience, and member needs.
Case Management Supervisor AlohaCareCase Management SupervisorHonolulu, HI$70,000–$83,000 / yearThe Care Management Supervisor Supervises the case management team and the care coordination of behavioral health members to promote quality and efficacy of care management delivery related to mental and behavioral health needs. Experience with individuals who have special health care needs, including HIV/AIDS, developmental disabilities, medically fragile, older adults, individuals with physical disabilities, housing insecurity, mental health and substance use disorder and other vulnerable needs.
Manager, Data Engineering (Master Data Management) MDM TriWest Healthcare AllianceManager, Data Engineering (Master Data Management) MDMHonolulu, HIRemoteFull timeTechnical Skills: In-depth knowledge of all application functionality, security, development, and system administration; knowledge of relevant technology, tools and middleware; proficient change agent; knowledge of the agile methodology and software maintenance and support. • Develops and maintains ongoing relationships with hardware, software, consultant, and employee resource vendors to insure that TriWest systems are adequately supported and external opportunities are understood and considered in the planning process.
Supervisor, Provider Network Management TriWest Healthcare AllianceSupervisor, Provider Network ManagementHonolulu, HIRemoteFull timeTechnical Skills: Working knowledge of provider contract support functions and provider data systems; proficient with Word, Excel, and Provider Services data systems, with the ability to produce reports through querying; working knowledge of VA policies and procedures outlined in the VA Operations Manual, VA Policy Manual, DoD Regulations, and applicable TRICARE contract requirements. • Bachelor's Degree and 2 years of varied and responsible experience with health care programs, or any combination of education and experience that provides an equivalent background, plus the following: • If supporting TRICARE contract, must be a U.S. Citizen.
Psychiatrist AlohaCarePsychiatristHonolulu, HI$110–$150 / hourProvides clinical oversight and guidance on Substance Use Disorder issues, including issues such as the use of ASAM or other evidence-based assessments and treatment protocols, the use of MAT, is active in teaching or training staff and, upon approval, students or professional trainees. The Community Care Services (CCS) Psychiatrist (“Psychiatrist”) ensures access to direct clinical support and services to members upon assignment and for ongoing care, in particular, the members at a Level 4 or 5 in severity.
Assistant Program Manager Spectrum Healthcare ResourcesAssistant Program ManagerHonolulu, HawaiiRemoteSpectrum Healthcare Resources has a potential opportunity for an Assistant Program Manager to support healthcare administrative operations serving Tripler Army Medical Center, Naval Health Clinic Hawaii, and military treatment facilities throughout the Pacific Northwest. Location: Location: US-HI-Honolulu Recruiter: Full Name: First Last: Laura Hatcher Direct phone number: 3147444156 Recruiter: Email: Laura_Hatcher@spectrumhealth.com
Program Manager Spectrum Healthcare ResourcesProgram ManagerHonolulu, HawaiiRemoteSpectrum Healthcare Resources has a potential opportunity for an experienced Program Manager to support healthcare administrative operations serving Tripler Army Medical Center, Naval Health Clinic Hawaii, and military treatment facilities throughout the Pacific Northwest. Location: Location: US-HI-Honolulu Recruiter: Full Name: First Last: Laura Hatcher Direct phone number: 3147444156 Recruiter: Email: Laura_Hatcher@spectrumhealth.com
Project Manager Sr TriWest Healthcare AllianceProject Manager SrHonolulu, HIRemoteFull timeTechnical Skills: Knowledge of the Managed Care concepts, proficient with statistical analysis, data management and analysis, project management techniques, benchmarking practices and techniques, quality improvement tools and techniques, presentations skills, and proficient with Excel, SQL, Word, PowerPoint, and Visio. Supports project implementation when required using project management tools to develop project plans/timelines, coordinate/manage project, monitor and report status, progress and areas of risk in relation to established project objectives, requirements and timelines.
Business Development Liaison (Full Time) Navian HawaiiBusiness Development Liaison (Full Time)HONOLULU, HI$74,000–$94,000 / yearThis role actively identifies new referral opportunities, conducts consistent field-based sales calls, builds relationships with referral sources and healthcare professionals, promotes organizational services through ongoing outreach and education, and identifies opportunities to generate new referrals. 1 year of experience in sales, business development, marketing, account management, community outreach, or healthcare-related relationship management Experience in hospice, palliative care, home health, senior living, healthcare services, or related healthcare sale preferred.