Manage the development and operation of an effective fraud, waste, and abuse program in accordance with CMS requirements and Federal Sentencing Guidelines
Perform and manage FWA investigations conducted by CareOregon staff, affiliates, and business partners
Complete and file all required Medicare and Medicaid filings and/or responses for FWA
Develop sufficient and accurate monthly FWA dashboards and corresponding summaries used to identify and monitor current compliance and trending of all FWA matters
Identify potential areas of FWA vulnerability and risk; partner with department leadership in developing and implementing corrective action plans for resolution of problematic issues
Manage team and recommend team direction and goals in alignment with organizational mission, vision, and values

As required by Medicaid contract, must be a professional investigator, paralegal, professional coder, 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 CareOregon’s Aspiring Leaders Program
Fraud, waste and abuse experience in Medicaid or Medicare

Medical, dental, vision, life, AD&D, and disability insurance
Health savings account
Flexible spending account(s)
Lifestyle spending account
Employee assistance program
Wellness program
Discounts
Multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings)
Strong retirement plan with employer contributions
PTO and Paid State Sick Time based on hours worked/scheduled hours
Paid holidays, volunteer time, jury duty, bereavement leave, and more

Special Investigations Unit Manager

Key skills