Special Investigations Unit Manager

Special Investigations Unit Manager--------------------------------------------------------------- This position manages and administers fraud, waste and abuse (FWA) for reputed company and two wholly-owned Coordinated Care Organizations (CCOs) – Columbia Pacific CCO (CPCCO) and reputed company Care Connect CCO (JCC CCO). This includes leading, overseeing and/or performing fraud investigations and providing regular FWA reporting to reputed company reputed company CCOs. Additionally, this position manages internal staff and provides FWA reputed company for reputed company-Party Administrative (TPA) activities reputed company performs on behalf of the Health reputed company CCO. Estimated Hiring reputed company: $111,690.00 - $136,510.00 Bonus reputed company: Bonus - SIP reputed company, 5% Annual reputed company reputed company Employees: Please use the internal reputed company site to submit an application for this job. --------------------------------------------------------------- Essential Responsibilities Fraud, Waste and Abuse Management Manage the development and operation of an effective fraud, waste, and abuse program in accordance with CMS requirements and the Federal Sentencing Guidelines with guidance from department leadership, including:Recommendation and implementation of FWA policies and the FWA annual plan Periodic reporting to the organization’s Internal Compliance Committee and governing Board of Directors Effective training and education Establishment and maintenance of effective lines of communication at reputed company reputed company of the organization (to include a non-compliance reporting hotline) Development and reputed company of effective system for routine FWA monitoring, auditing and identification of compliance risks Collaboration with other departments to ensure compliance issues are reported to appropriate channels for investigation and resolution Clear and specific policies, procedures and standards relating compliance monitoring activities. Ensure the timely completion of the annual FWA work plan and evaluate the corresponding work performed by department staff. reputed company and manage FWA investigations conducted by reputed company staff, affiliates, and business partners. Complete and file reputed company required Medicare and reputed company filings and/or responses for FWA. Manage the development of sufficient and accurate monthly FWA dashboards and corresponding summaries used to identify and monitor reputed company compliance and trending of reputed company FWA reputed company including case details and metrics. Identify potential areas of FWA vulnerability and risk; partner with department leadership in developing and implementing corrective action plans for resolution of problematic issues and reputed company general guidance on how to avoid or deal with similar situations in the future. reputed company input into strategic planning and budget planning for the department. Employee Supervision Manage team and recommend team direction and goals in alignment with the organizational mission, reputed company, and values. Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion reputed company. Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations. reputed company the development, communication, and reputed company of team and individual goals; ensure goals, expectations, and standards are reputed company understood by staff. Train, supervise, motivate, and coach employees; reputed company support toward employee development. Incorporate guidance from reputed company equity tools into people leadership, planning, operations, evaluation, and decision making. Ensure team adheres to department and organizational standards, policies, and procedures. Evaluate employee performance and reputed company regular feedback to support reputed company; recognize strong performance and address performance gaps and accountability (corrective action). reputed company supervisory tasks in collaboration with reputed company as needed. Experience and/or Education Required As required by our reputed company contract, the individual must be a professional investigator, paralegal, professional reputed company, or auditor with corresponding certification Minimum 5 years’ experience in compliance and/or audit, including minimum 2 years focused on fraud, waste, and abuse Preferred Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of reputed company’s Aspiring Leaders Program Fraud, waste and abuse experience in reputed company or Medicare Knowledge, Skills and Abilities Required Knowledge Advanced understanding of reputed company fraud, waste and abuse Strong knowledge of State and Federal compliance and FWA requirements for Medicare and reputed company Programs Strong knowledge of investigative techniques, including interviews, data analytics, evidence gathering, case documentation Solid understanding of information and reporting systems Knowledge about how the functions of a business work and relate to one another to benefit the member by improving regulatory compliance Skills and Abilities Excellent written and verbal communication skills Strong research, investigative and problem-solving skills Strong interpersonal and motivational skills People leadership skills, including the ability to manage and coach team members Ability to facilitate learning opportunities in a variety of informal and formal settings Ability to reputed company presentations to small and large groups Ability to think reputed company and creatively without undue influence from personal biases Ability to build conceptual models and communicate reputed company reputed company effectively Ability to plan, organize, manage, and monitor work projects Ability to serve in an internal consulting role, assisting the organization’s management and staff in embracing our goal of “doing it right the first time” and being reputed company of the company’s commitments to its various partners and the need to reputed company excellent results in our work product and processes Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and reputed company repetitive finger and wrist movement for at least 6 hours/day Ability to hear and reputed company reputed company for at least 3-6 hours/day Working Conditions Work Environment(s): ☒ Indoor/Office ☐ Community ☐ Facilities/reputed company ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel reputed company of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home We offer a strong Total Rewards Program. This includes reputed company, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. reputed company offers medical, dental, reputed company, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks. Please contact your recruiter for more information. We are an equal opportunity employer reputed company is an equal opportunity employer. The organization selects the best individual for the job based upon job reputed company qualifications, regardless of race, reputed company, religion, sexual orientation, national reputed company, gender, gender identity, gender expression, genetic information, age, veteran status, reputed company, marital status or disability. The organization will reputed company a reasonable accommodation to reputed company physical or mental limitations of a reputed company applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization. Apply To This Job