DescriptionThe Special Investigations Unit Manager leads and monitors investigations of allegations of fraudulent and abusive practices. The Special Investigations Unit Manager works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Position will also require engagement with governing state Medicaid agencies and assistance with Medicaid compliance reporting , which includes understanding and conducting analysis of MCO contracts.
The Special Investigations Unit Manager assists coordinating investigation with law enforcement authorities. Leads team/investigators in assembling of evidence and documentation to support successful adjudication, where appropriate.Monitors/Leads investigations toensuring appropriateness of billing practices using a variety of investigational tools. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department.
Scheduled Weekly Hours40