Job Details

Program Oversight/Leadership for FWA SIU:Provide strategic oversight of the FWA SIU programEnsure compliance with all applicable FWA regulatory requirementsMaintain independence and objectivity of SIU investigationsOversee intake, prioritization, and outcomes of investigationsReview and approve investigative findings and referralsEscalate significant FWA risks to executive leadershipOversee vendor and delegated FWA/SIU activitiesMonitor FWA trends, metrics, and program effectivenessOversee FWA related reportingSupport audit readiness and regulatory inquiriesCross-Functional Team Partnerships:Partner with Compliance to ensure regulatory alignment and audit readinessCollaborate with Medical Management on utilization and clinical FWA risksCoordinate with Provider Relations on provider actions and remediationWork with Finance on recoveries, overpayments, and financial reportingCoordinate with Legal as appropriate on investigations, and enforcement actionsSupport Operations with FWA education, guidance, and risk mitigationCoordinate with delegated entities and vendors on FWA oversight and reportingServe as the primary SIU liaison to internal and external stakeholdersLeadership:Selects, trains, develops and organizes staff.Monitors overall inventory of work and prioritizes the staff's work to meet performance standards and authorizes additional resources as needed.Provides feedback and coaching (helping individuals to solve problems/issues on their own) including timely completion of any interim and year-end performance reviews.Performs all other miscellaneous responsibilities and duties as assigned or directed.#LI-Hybrid