Our client is seeking an experienced Special Investigation Unit (SIU) Manager to oversee fraud, waste, and abuse investigative activities within a healthcare environment. This individual will lead investigative efforts, support compliance initiatives, manage stakeholder relationships, and ensure adherence to state and federal regulations.
The ideal candidate will possess strong leadership skills, experience conducting healthcare investigations, and a deep understanding of fraud prevention methodologies. The SIU Manager will collaborate closely with internal teams, participate in statewide meetings, and drive investigative excellence across the organization.
Mandatory Requirements:
1. Accountable for establishing and maintaining a relationship with AHCA-Medicaid Program Integrity as part of CCP’s Medicaid FWA program, including but not limited to attendance at collaborative meetings and responding to AHCA-MPI inquiries.
2. Oversee the Managed Care Plan’s fraud and abuse dete...