Head of Pharmacy Fraud & Network Integrity
Horizon-Blue-Cross-Blue-Shield-of-New-Jersey
Horizon Blue Cross Blue Shield of New Jersey seeks a Pharmacist leader to oversee the Pharmacy Fraud, Waste and Abuse program. You will coordinate with regulatory agencies, design utilization management edits, and lead audits and staff training to ensure compliance and program effectiveness. Ideal candidates hold a PharmD with NJ licensure, 5+ years in pharmaceutical practice, and 3+ years in pharmacy auditing or managed care. The role is hybrid, with travel across New Jersey for audits. #J-18808-Ljbffr Horizon-Blue-Cross-Blue-Shield-of-New-Jersey
$109.6k - $149.63k
...Company succeeds. About The Role Leads all program efforts and collaboration with applicable regulatory agencies associated with all Pharmacy Fraud, Waste, and Abuse program and efforts, i.e. NJ Medicaid Fraud Division, Federal Bureau of Investigation, Medicaid Fraud Control...NetworkFraudLive inWork at officeLocal area2 days per week1 day per week- ...program, the regional payer landscape, and pharmacy channel access. The FAM will help... ...patient claims data. Knowledge of Integrated Delivery Network/Integrated Health Systems. Strong understanding... ...EVERSANA. Recruitment fraud is a sophisticated scam commonly perpetrated...NetworkFraudWork at officeLocal area
$25k
...Job Title: Head of Board and Council Engagement Team: External Affairs Location: Hybrid in Atlanta (GA), Chicago (IL) strongly preferred... ...additionally, we work to build boards and councils that provide networks, accounting for 35% of our overall revenue annually Support the...NetworkFull timeWork experience placementWork at officeLocal areaImmediate startRemote workVisa sponsorshipWork visa2 days per week3 days per week- ...The Healthcare Business Analyst – Pharmacy API Integrations is responsible for managing and improving API integrations between the organization... ...research, and participation in relevant professional networks. Follow established security, privacy, and administrative...NetworkFull time
$125.1k - $225.2k
...possible.Job Description:Job Title: IT Network Manager - NY/NJPosition Summary:We are seeking... ...org templates, change control, and SIEM integration.Manage remote access solutions and... ...practices. To learn more about recruitment fraud and how to report it, please refer to ....NetworkFraudFull timeRemote workFlexible hours$230k - $250k
...care; COE’s - Academic / IDN’s, integrated health systems and community... ...and access processes through Pharmacy & Therapeutics committees,... ...managing Integrated Delivery Networks (IDNs), or other organized customer... ...policy for candidate fraud. All information and credentials...NetworkFraudFull timePart timeLocal areaImmediate startWorldwide$25 - $40 per hour
...investigators with experience handling insurance fraud investigations, obtaining statements, and... ...? Join a respected nationwide network of experienced investigators and law enforcement... ...investigations. At Origin, we value integrity, professionalism, sound judgment, and the...NetworkFraudHourly payFlexible hours$111k - $216k
...environments for AI workloads, including private networking and restricted egress designs.• Mentor... ...-NW1ABOUT THE FIRMK&L Gates is a fully integrated global law firm with lawyers located in... ...)Identity Protection/Restoration and Fraud InsuranceParental Leave (18 weeks of...NetworkFraudFull timeTemporary workLocal areaRemote work$180.97k - $280k
...application of technology in legal practice. By integrating legal, business, and technical expertise... ...informed and connected to professional networks on emerging AI technologies and legal... ...Protection/Restoration and Fraud InsuranceLife Insurance (including Basic...NetworkFraudFull timeTemporary workLocal areaImmediate startRemote work- ...Provider Network Management Senior AssociateLocation & Work Environment: This is a hybrid... ...provider partners are seamlessly integrated into WelbeHealth's commitment to serve frail... ...employment equipment. You can report suspected scam activity to fraud.****@*****.***...NetworkFraud
$41.86k - $127.46k
...values of Vigilance, Service to Country and Integrity. As a Customs and Border Protection... ...documents or goods for criminal activity, fraud, and/or illegal operations. Utilizing... ...site. You will be linked to the CBP Talent Network registration page. For Position of...NetworkFraudFull timeContract workWork at officeLocal areaImmediate start$250k
...control policies/procedures, preventing fraud and protecting customer assets. Takes ownership... ...by Wilmington Trust. M&T Bank has a network of over 1,000 branches and 2,200 ATMs that... ...time, each year. Our core values – integrity, ownership, collaboration, curiosity, and...NetworkFraudTemporary workWork at officeLocal area$170k - $180k
...insight.Identify and escalate collateral-integrity or cash-reconciliation anomalies, such... ...expected collateral or cash, that may signal fraud, double-pledging, or other data-... ...flexibility of work from home, as well as the networking and career development of in-person work...NetworkFraudFull timePart timeWork from home$41.86k - $127.46k
...values of Vigilance, Service to Country and Integrity. \n As a Customs and Border Protection... ...or goods for criminal activity, fraud, and/or illegal operations. \n Utilizing... ...site. You will be linked to the CBP Talent Network registration page. For Position of Interest...NetworkFraudFull timeContract workWork at officeLocal areaImmediate start$25 per hour
...streamlining account management or enhancing fraud detection processes. Assist in... ...boost colleague morale and drive colleague networking Utilize tools like SharePoint, Teams, Excel... ...for entrepreneurs and that legacy of integrity, community and unparalleled client relationships...NetworkFraudHourly payFull timeInternshipWork at officeRemote work$98.07k - $183.9k
...security-table design, and deployment-time integrity checks (for example, guarding against... ...storage, identity management, DevOps, and networking.Demonstrated implementation experience... ...year)Identity Protection/Restoration and Fraud InsuranceParental Leave (18 weeks of...NetworkFraudFull timeTemporary workLocal areaRemote work$158.3k - $293.9k
...performance, and cost efficiency.DevOps Integration: Incorporating DevOps principles like CI... ...create and maintain formal and informal networks.Ability to publicly represent the company... ...due to a disability.Recruitment fraud is a scheme in which fictitious job opportunities...NetworkFraudMinimum wageFull timeContract workRemote workFlexible hours$85k - $90k
...Job Type: Full-Time Reports To: Head of Digital Location: Newark,... ...European population than any other network operator. The Role The... ...CRM, and Digital Marketing) to integrate affiliate efforts with overall... ...Familiarity with compliance and fraud prevention in affiliate marketing...NetworkFraudFull timeRelocation- ...computer hacking, digital piracy, electronic fraud and theft, and other forms of... ...cross-disciplinary research and programs integrating criminal justice with computer science/cybersecurity... ...teaching experience in subjects such as network security; willingness and ability to...NetworkFraudFull time
- ...Science - FraudJob SummaryThe Manager, Fraud Data Science is responsible for the performance... ...uptime, transaction processing, integrations, third-party data providers, and system... ...applying AI/machine learning, graph analytics, network analysis, generative AI, or other...NetworkFraud
$133.6k - $220.4k
...identity platforms, adaptive authentication, fraud and risk detection, software engineering... ...journeys, CIAM APIs, mobile and web integrations, fraud and risk controls, and platform... ...behavior, device identifiers, CORS/CSP, network failures, application lifecycle transitions...NetworkFraudFull timeContract workPart time- ...by forecasting claim severity, detecting fraud, identifying subrogation opportunities,... ...building high quality prediction systems integrated with our products.... ...techniques and algorithms, including Neural Networks, Text Mining, etc.Experience with Keras,...NetworkFraud
- ...Our client seeks a Field Tactical Network Engineer to serve as a subject matter expert... ...across systems engineering leads to address integration challenges and evolving requirements.... ...of fraudulent activity, please contact fraud@eliassen.com. About Eliassen Group...NetworkFraudHourly payContract workLocal areaNight shift
- ...payments, partnering closely with Engineering, Product, Fraud, Servicing, Network, Legal, Compliance, Risk, UX, and external partners to build... ...requirements and specifications for data sharing and integrations with merchants, payment service providers, and AI/LLM partners...NetworkFraudFull timeContract work
- ...economy. Today, that means one integration, one account view, and one... ...The Role We're hiring a Head of Risk & Agentic Operations... ...our sponsor bank and the card networks for the merchant book. You... ...strategy, chargeback and fraud thresholds, card-network monitoring...NetworkFraud
- ...SCADA and Energy Management System (EMS) integration, including RTUs, RTACs, HMIs, historians... ...RTUs, protective relays, and industrial networking. Working knowledge of electrical... ...discrimination. PROTECT YOURSELF FROM FRAUD Please be aware that Soltage emails...NetworkFraudFull timeWork at officeRemote work
- ...scaling payment products and payment platform integrations.This role will own the strategy, roadmap... ...processors, gateways, banks, payment networks, lockbox providers, MoneyGram and other... ...security and risk: understanding of fraud, risk, compliance, security, and payment...NetworkFraudWork at office3 days per week
$74.8k - $130.9k
...Preferred Qualifications:Exposure to Cisco Meraki systems or similar networking tools.Basic understanding of endpoint management tools like... ...recruitment practices. To learn more about recruitment fraud and how to report it, please refer to .SummaryLocation: US - NJ...NetworkFraudFull timeFlexible hours- ...Eclipse New York is looking for an exceptional, commercially driven Head of TikTok Shop & Social Commerce to build TikTok Shop into a... ...York . You will have built a substantial affiliate creator network, established repeatable creator-seeding and content systems,...Network
$112.2k - $196.4k
...Strong understanding of enterprise IT, cloud (Azure preferred), networking, and cybersecurity.Strong stakeholder coordination and... ...fraudulent recruitment practices. To learn more about recruitment fraud and how to report it, please refer to .SummaryLocation: US - NY...NetworkFraudFull timeRemote workFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Head of Pharmacy Fraud & Network Integrity. Be the first to apply!
- fraud manager Newark, NJ
- fraud prevention Newark, NJ
- financial fraud Newark, NJ
- IT network Newark, NJ
- network intern Newark, NJ
- senior cloud network engineer Newark, NJ
- director network services Newark, NJ
- director of network operations Newark, NJ
- vice president network management Newark, NJ
- provider network consultant Newark, NJ




