Mgr Special Investigative Unit-Remote-Must reside in CaliforniaMolina Healthcare United States; United States Job ID 2020353
Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by overseeing, follow-up and resolution of investigations.
- Provides oversight and review of the SIU referral intake and investigation process while giving guidance and direction to team on case investigation steps and actions.
- Works with leadership to maintain and revise policies and procedures, fraud, waste, and abuse plans, annual audit work plans, including department guidance memos, and educational materials.
- Identifies opportunities for improvement through the audit process and provide recommendations for system enhancement to augment investigative outcomes and performance.
- Accurately tracks, reports, and follows up on overpayments and recoveries
- Leads business requirement process and reporting to ensure proper and timely notification of case activity to the appropriate regulatory and/or law enforcement agency.
Bachelor's Degree or equivalent combination of education and experience
- 5-7 years
- Required License, Certification, Association
- Active and unrestricted Accredited Health Care Fraud Investigator (AHFI) designation or Certified Fraud Examiner (CFE)
Master’s Degree preferred; will consider previous experience in health plan setting in government programs
- 7-9 years
- Preferred License, Certification, Association
- Health Care Anti-Fraud Associate (HCAFA) designation
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.Job Type: Full Time Posting Date: 05/25/2023
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