Investigator jobs at Molina Healthcare - 113 jobs

The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for other investigators. Qualified candidates must live in Massachusetts or surrounding states. Essential Functions: Develop, coordinate and conduct strategic fact-driven investigative projects including business process review, execution of investigative activities, and development of investigation outcome recommendations Manage the development, production, and validation of reports generated from detailed claims, eligibility, pharmacy, and clinical data and translate analytical findings into actionable items Manage strategic investigative plan and drive investigative outcome for the team Ensure quality outcomes for investigative team through auditing and oversight Prioritize, track, and report status of investigations Report identified corporate financial impact issues Use concepts and knowledge of coding guidelines to analyze complex provider claim submissions Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach Collaborate with data analytics team and utilize RAT STATS on Statistically Valid Random Sampling Coordinate and conduct on-site and desk audits of medical record reviews and claim audits Manage and decision claims pended for investigative purposes Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for various provider specialty types Prepare and conduct in-depth complex interviews relevant to investigative plan Execute and manage provider formal corrective action plans Participate in meetings with operational departments, business partners, and regulatory partners to facilitate investigative case development Participate in meetings with Legal General Counsel to drive case legal actions, formal corrective actions, negotiations with recovery efforts, settlement agreements, and preparation of evidentiary documents for litigation Present, support, and defend investigative research to seek approval for formal corrective actions Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention SME in the designated market and ability to apply external intelligence to their analysis and case development Develop and present internal and external formal presentations, as needed Attend fraud, waste, and abuse training/conferences, as needed Support regulatory fraud, waste, and abuse reports to federal and state Medicare/Medicaid agencies Manage and maintain sensitive confidential investigative information Maintain compliance with state and federal laws and regulations and contracts Adhere to the CareSource Corporate Compliance Plan and the Anti-Fraud Plan Assist in Federal and State regulatory audits, as needed Perform any other job-related instructions, as requested Education and Experience: Bachelor's Degree or equivalent years of relevant work experience in Health-Related Field, Law Enforcement, or Insurance required Master's Degree (e.g., criminal justice, public health, mathematics, statistics, health economics, nursing) preferred Minimum of five (5) years of experience in healthcare fraud investigations, medical coding, pharmacy, medical research, auditing, data analytics or related field is required Competencies, Knowledge and Skills: Intermediate proficiency level in Microsoft Office to include Outlook, Word, Excel, Access, and PowerPoint Effective listening and critical thinking skills and the ability to identify gaps in logic Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties Excellent problem solving and decision making skills with attention to details Background in research and drawing conclusions Ability to perform intermediate data analysis and to articulate understanding of findings Ability to work under limited supervision with moderate latitude for initiative and independent judgment Ability to manage demanding investigative case load Ability to develop, prioritize and accomplish goals Self-motivated, self-directed Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences Presentation experience, beneficial Knowledge of Medicaid, Medicare, healthcare rules preferred Background in medical terminology, CPT, HCPCS, ICD codes or medical billing preferred Complex project management skills preferred Display leadership qualities Licensure and Certification: One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) is preferred NHCAA or other fraud and abuse investigation training is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Occasional travel (up to 10%) to attend meetings, training, and conferences may be required Compensation Range: $72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-SD1

The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for other investigators. Qualified candidates must live in Massachusetts or surrounding states. Essential Functions: Develop, coordinate and conduct strategic fact-driven investigative projects including business process review, execution of investigative activities, and development of investigation outcome recommendations Manage the development, production, and validation of reports generated from detailed claims, eligibility, pharmacy, and clinical data and translate analytical findings into actionable items Manage strategic investigative plan and drive investigative outcome for the team Ensure quality outcomes for investigative team through auditing and oversight Prioritize, track, and report status of investigations Report identified corporate financial impact issues Use concepts and knowledge of coding guidelines to analyze complex provider claim submissions Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach Collaborate with data analytics team and utilize RAT STATS on Statistically Valid Random Sampling Coordinate and conduct on-site and desk audits of medical record reviews and claim audits Manage and decision claims pended for investigative purposes Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for various provider specialty types Prepare and conduct in-depth complex interviews relevant to investigative plan Execute and manage provider formal corrective action plans Participate in meetings with operational departments, business partners, and regulatory partners to facilitate investigative case development Participate in meetings with Legal General Counsel to drive case legal actions, formal corrective actions, negotiations with recovery efforts, settlement agreements, and preparation of evidentiary documents for litigation Present, support, and defend investigative research to seek approval for formal corrective actions Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention SME in the designated market and ability to apply external intelligence to their analysis and case development Develop and present internal and external formal presentations, as needed Attend fraud, waste, and abuse training/conferences, as needed Support regulatory fraud, waste, and abuse reports to federal and state Medicare/Medicaid agencies Manage and maintain sensitive confidential investigative information Maintain compliance with state and federal laws and regulations and contracts Adhere to the CareSource Corporate Compliance Plan and the Anti-Fraud Plan Assist in Federal and State regulatory audits, as needed Perform any other job-related instructions, as requested Education and Experience: Bachelor's Degree or equivalent years of relevant work experience in Health-Related Field, Law Enforcement, or Insurance required Master's Degree (e.g., criminal justice, public health, mathematics, statistics, health economics, nursing) preferred Minimum of five (5) years of experience in healthcare fraud investigations, medical coding, pharmacy, medical research, auditing, data analytics or related field is required Competencies, Knowledge and Skills: Intermediate proficiency level in Microsoft Office to include Outlook, Word, Excel, Access, and PowerPoint Effective listening and critical thinking skills and the ability to identify gaps in logic Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties Excellent problem solving and decision making skills with attention to details Background in research and drawing conclusions Ability to perform intermediate data analysis and to articulate understanding of findings Ability to work under limited supervision with moderate latitude for initiative and independent judgment Ability to manage demanding investigative case load Ability to develop, prioritize and accomplish goals Self-motivated, self-directed Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences Presentation experience, beneficial Knowledge of Medicaid, Medicare, healthcare rules preferred Background in medical terminology, CPT, HCPCS, ICD codes or medical billing preferred Complex project management skills preferred Display leadership qualities Licensure and Certification: One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) is preferred NHCAA or other fraud and abuse investigation training is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Occasional travel (up to 10%) to attend meetings, training, and conferences may be required Compensation Range: $70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SD1

Reporting to the Director of Police and Security, the Investigator is responsible for conducting thorough criminal and non-criminal investigations, enforcing Institute policies, and supporting crime prevention efforts. This includes interviewing witnesses and suspects, preparing cases for prosecution or administrative review, and ensuring compliance with state and local laws. The Investigator serves as a key liaison with external law enforcement agencies and courts, while also assisting with program development, system improvements, and training initiatives. All responsibilities must be carried out in alignment with the Institute's mission and core values. The Investigator also provides direct support to victims of domestic or workplace violence, which may include safety planning, threat assessments, court escorts, and workplace or home security surveys. When required, the Investigator conducts vehicle escorts to ensure safe travel to and from court or other designated locations. Additionally, the Investigator performs background checks on prospective department employees and reviews adverse findings for Institute candidates under recruitment. These investigations must be conducted promptly, thoroughly, and documented with clear recommendations to the appropriate hiring authority. Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals. **PRIMARY DUTIES AND RESPONSIBILITIES:** - Conduct unbiased investigations into criminal activity or policy violations on Institute property. - Interview victims and witnesses, document findings, and maintain accurate case files. - Apprehend suspects or offenders when appropriate. - Serve as liaison with law enforcement agencies and courts. Prepare individuals for testimony and provide testimony as required. - Provide executive protection services as assigned. - Conduct threat assessments, safety audits, and risk assessments. Document and report findings for management action. - Monitor and analyze crime trends, including potential threats from groups or individuals. **KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:** - Strong leadership, investigative, communication, and risk assessment skills. - Ability to manage complex interpersonal situations and respond effectively in crisis situations. - Reliable, adaptable, and able to work independently or as part of a team. - Skilled in preparing clear, concise reports and correspondence. - Proficiency with modern productivity applications (e.g., Microsoft Office, case management systems). **MINIMUM JOB QUALIFICATIONS:** High School diploma, bachelor's degree in criminal justice or related field preferred. 5 years of experience in Security, Law Enforcement, or Military Service. 7 years of experience in Security, Law Enforcement, or Military Service preferred. **LICENSE/CERTIFICATION/REGISTRATION REQUIRED:** - Must successfully complete an initial and annual criminal background check. - Valid Massachusetts Driver's License required. - Must obtain and maintain certifications (training provided by the department) in: o CPR/AED/First Aid o Narcan (Naloxone) Training o AVADE/HDTS De-Escalation Training o International Association of Healthcare Safety and Security (IAHSS) Supervisor Certification (Basic, Advanced, and Supervisor) within one year of hire o Eligibility for licensure as a Special State Police Officer under Massachusetts General Laws Chapter 22C, Section 63 strongly preferred. If licensed, must meet all ongoing training and compliance requirements. **SUPERVISORY RESPONSIBILITIES:** None **PATIENT CONTACT:** Yes, indirect contact for non-care providing purposes. At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to apply. Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law. **EEO Poster** . Pay Transparency Statement The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate's relevant experience, skills and qualifications. For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA). $72,300.00 - $89,300.00

A bit about this role: Are you a highly analytical and experienced investigator with a passion for uncovering the truth and protecting vital healthcare resources? Our Special Investigations Unit (SIU) is looking for a skilled Investigator to join our dedicated team. In this crucial role, you'll be at the forefront of preventing, detecting, and responding to healthcare fraud, waste, and abuse (FWA), safeguarding our members and the integrity of the Medicare Fund. If you're driven by meticulous investigation, data-driven insights, and a commitment to justice, we encourage you to apply. Responsibilities and Impact will include: As an SIU Investigator, you'll be responsible for the full lifecycle of complex FWA investigations, acting as a subject matter expert and collaborating with various stakeholders. Your key responsibilities will include: Lead Complex Investigations: Plan, organize, and execute specialized investigations into allegations of healthcare fraud, waste, and abuse. This includes handling intricate cases requiring advanced investigative knowledge and skills. Data-Driven Detection: Utilize advanced data mining and analysis techniques to identify aberrancies and outliers in claims, medical records, enrollment, and other healthcare transactions. You'll independently research FWA issues and employ cutting-edge investigative resources. Expert Guidance: Serve as a subject matter expert for other SIU Investigators, providing specialized knowledge and guidance to elevate team capabilities. Policy & Strategy Development: Contribute to the development of robust policies and procedures related to FWA detection and investigation, as well as the annual SIU risk assessment and work plan. Thorough Documentation & Reporting: Conduct comprehensive FWA investigations, ensuring complete and accurate case documentation and detailed investigative reports that adhere to SIU policies and standards. External Referrals & Collaboration: Prepare comprehensive summary and detailed reports on investigative findings for referral to federal and state agencies, ensuring full compliance with regulatory requirements. You'll also actively participate in OIG Healthcare Fraud Workgroups. Stakeholder Engagement: Collaborate closely with internal stakeholders (e.g., FWA Monthly Workgroup, Market/Network, Credentialing Committee) to share updates on FWA schemes, coordinate recommendations, and facilitate fund recovery or other necessary actions. Provider Education: Conduct impactful provider education sessions as a direct response to investigation findings and audits. Liaison & Point of Contact: Serve as a key point of contact for corporate and field inquiries regarding FWA, and participate in meetings with providers, business partners, regulatory agencies, and law enforcement. Training & Development: Assist in developing and presenting engaging FWA training programs for internal and external audiences. Required skills and experience: Education: A Bachelor's Degree in Business, Criminal Justice, Healthcare, or a related field, or equivalent relevant work experience. Experience: Minimum of 3 years of dedicated experience in health insurance fraud investigation. Proven experience within Medicare and/or Medicaid programs, specifically with medical claim billing, reimbursement, audit, or provider contracting. Demonstrated experience with data analysis techniques. Experience with the Healthcare Fraud Shield platform is a significant plus. Exceptional Analytical Skills: Ability to interpret and dissect complex data sets, identifying patterns and anomalies indicative of FWA. Outstanding Communication: Excellent written and verbal communication skills are essential for clear report writing, compelling presentations, and effective stakeholder engagement. Integrity & Detail-Oriented: A strong commitment to integrity and compliance, coupled with meticulous attention to detail in all aspects of investigations. Independent & Collaborative: Proven ability to work independently, manage a diverse caseload of investigations, and thrive in a fast-paced environment, while also excelling in collaborative team settings. Strong Organizational Skills: Highly organized with the ability to manage multiple complex investigations simultaneously and effectively prioritize tasks. Desired skills and experience: Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) #LI-DS1 #LI-Remote Salary range: $55,000 - $100,000 annually The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more.... *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible. Healthcare equality is at the center of Devoted's mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we're on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That's why we're gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company - one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission! Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory requirements. The Special Investigations Unit Investigator II is responsible for conducting full investigations to proactively prevent, detect, and correct suspected and identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and/or Federal regulatory agencies. The incumbent makes potential fraud, waste, or abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. The Special Investigations Unit Investigator II conducts monitoring and supports the Plan's Fraud, Waste and Abuse Program (FWA) to ensure compliance with State and/or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC), and the California Department of Health Care Services (DHCS). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary. Hybrid schedule. CalPERS retirement. State of the art fitness center on-site. Medical Insurance with Dental and Vision. Life, short-term, and long-term disability options Career advancement opportunities and professional development. Wellness programs that promote a healthy work-life balance. Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Identify, investigate, and analyze instances of alleged Fraud, Waste and Abuse (FWA) in accordance with regulatory requirements. Develop leads presented to the SIU to assess and determine whether potential FWA is corroborated by evidence. Conduct both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification, develop recommendations, preparation of overpayment identifications, and closure of investigative cases. Prepare detailed preliminary and extensive investigation referrals to Federal and/or State regulatory and/or law enforcement agencies when potential FWA is identified as required by regulatory and/or contract requirements. Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. Prepare audit results letters to providers when overpayments are identified. Prepare and conduct in-depth complex interviews relevant to investigative plan. Present, support, and defend investigative research to seek approval for formal corrective actions. Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention. Support regulatory communication requests as required, including providing claims data analysis, medical policy guidelines, and other documents/information. Support the FWA Program's short and long-term goals, as developed by Management, to prevent, detect, and correct issues of fraud, waste, and abuse. Review the FWA Program's policies and procedures, guidelines, practices, templates, and tools and make recommendations for revisions, as identified. Identify potential risks, non-compliance and/or alleged violations within the Plan or with external partners and issue root cause analysis/corrective action plans, as appropriate. Collaborate with internal partners on FWA intelligence and initiatives and assist with tracking and trending to identify potential fraud, waste, and abuse. Coordinate with Compliance Auditors as it relates to FWA issues and help implement process improvement measures to prevent, correct, and mitigate those risks in the future. Perform any other duties as assigned to ensure Plan operations are successful. Qualifications Education & Requirements Four (4) or more years relevant professional experience in a health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting requirements Experience in health care fraud investigation, detection, and/or healthcare related specialty including but limited to; Pharmacy, DEM, Mental Health, Behavioral Health, Hospice, Home Health, claims, or claims processing preferred Bachelor's degree from an accredited institution In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position This experience is in addition to the minimum years listed in the Experience Requirements above Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification/licensure preferred Key Qualifications Strong knowledge of Managed Care, Medi-Cal, and Medicare programs as well as Marketplace Compliance program principles and practices of managed care. Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, coding Excellent verbal and written communication skills with thorough documentation, composing detailed investigative reports and professional internal and external correspondence Interpersonal and presentation skills to communicate with internal departments and external agencies Demonstrated analytical, problem solving, and resolution skills Strong organizational skills and attention to detail. Proficiency in Microsoft Office programs including, but not limited to: Word, Excel, PowerPoint, Outlook, and Access Demonstrated proficiency in data mining and the use of data analytics to detect fraud, waste, and abuse, including the utilization of pivot tables, formulas, and trending Proven ability to: Work independently and collaboratively within a team environment. Apply knowledge, and address situations appropriately with minimal guidance Manage multiple projects with competing deadlines and changing priorities Research, comprehend and interpret various state specific Medicaid, Federal Medicare, and ACA/Exchange laws, rules and guidelines Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach Minimal physical activity; may include standing, walking, sitting lifting, and pushing and carrying up to 25 lbs Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range USD $80,059.20 - USD $106,059.20 /Yr.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory requirements. The Special Investigations Unit Investigator II is responsible for conducting full investigations to proactively prevent, detect, and correct suspected and identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and/or Federal regulatory agencies. The incumbent makes potential fraud, waste, or abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. The Special Investigations Unit Investigator II conducts monitoring and supports the Plan's Fraud, Waste and Abuse Program (FWA) to ensure compliance with State and/or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC), and the California Department of Health Care Services (DHCS). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary. * Hybrid schedule. * CalPERS retirement. * State of the art fitness center on-site. * Medical Insurance with Dental and Vision. * Life, short-term, and long-term disability options * Career advancement opportunities and professional development. * Wellness programs that promote a healthy work-life balance. * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * Four (4) or more years relevant professional experience in a health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting requirements * Experience in health care fraud investigation, detection, and/or healthcare related specialty including but limited to; Pharmacy, DEM, Mental Health, Behavioral Health, Hospice, Home Health, claims, or claims processing preferred * Bachelor's degree from an accredited institution * In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position * This experience is in addition to the minimum years listed in the Experience Requirements above * Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification/licensure preferred Key Qualifications * Strong knowledge of Managed Care, Medi-Cal, and Medicare programs as well as Marketplace * Compliance program principles and practices of managed care. Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, coding * Excellent verbal and written communication skills with thorough documentation, composing detailed investigative reports and professional internal and external correspondence * Interpersonal and presentation skills to communicate with internal departments and external agencies * Demonstrated analytical, problem solving, and resolution skills * Strong organizational skills and attention to detail. Proficiency in Microsoft Office programs including, but not limited to: Word, Excel, PowerPoint, Outlook, and Access * Demonstrated proficiency in data mining and the use of data analytics to detect fraud, waste, and abuse, including the utilization of pivot tables, formulas, and trending * Proven ability to: * Work independently and collaboratively within a team environment. * Apply knowledge, and address situations appropriately with minimal guidance * Manage multiple projects with competing deadlines and changing priorities * Research, comprehend and interpret various state specific Medicaid, Federal Medicare, and ACA/Exchange laws, rules and guidelines * Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach * Minimal physical activity; may include standing, walking, sitting lifting, and pushing and carrying up to 25 lbs Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $80,059.20 USD Annually - $106,059.20 USD Annually

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! The Special Investigations Unit Investigator II investigates and analyzes incidents of suspected fraud, waste, and abuse in accordance with regulatory requirements. The Special Investigations Unit Investigator II is responsible for conducting full investigations to proactively prevent, detect, and correct suspected and identified issues of fraud, waste, and abuse in the health care environment, including reporting to State and/or Federal regulatory agencies. The incumbent makes potential fraud, waste, or abuse determinations by utilizing a variety of sources including data analytics to detect unusual billing. The Special Investigations Unit Investigator II conducts monitoring and supports the Plan's Fraud, Waste and Abuse Program (FWA) to ensure compliance with State and/or Federal contracts, laws, regulations, and guidance set forth by the Centers for Medicare and Medicaid Services (CMS), the United States Health and Human Services Office of the Inspector General (HHS-OIG), the California Department of Managed Health Care (DMHC), and the California Department of Health Care Services (DHCS). Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary. Hybrid schedule. CalPERS retirement. State of the art fitness center on-site. Medical Insurance with Dental and Vision. Life, short-term, and long-term disability options Career advancement opportunities and professional development. Wellness programs that promote a healthy work-life balance. Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Identify, investigate, and analyze instances of alleged Fraud, Waste and Abuse (FWA) in accordance with regulatory requirements. Develop leads presented to the SIU to assess and determine whether potential FWA is corroborated by evidence. Conduct both preliminary assessments of FWA allegations, and end to end full investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program regulation research, provider and member education, findings identification, develop recommendations, preparation of overpayment identifications, and closure of investigative cases. Prepare detailed preliminary and extensive investigation referrals to Federal and/or State regulatory and/or law enforcement agencies when potential FWA is identified as required by regulatory and/or contract requirements. Render provider education on appropriate practices (e.g., coding) as appropriate based on national or local guidelines, contractual, and/or regulatory requirements. Prepare audit results letters to providers when overpayments are identified. Prepare and conduct in-depth complex interviews relevant to investigative plan. Present, support, and defend investigative research to seek approval for formal corrective actions. Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention. Support regulatory communication requests as required, including providing claims data analysis, medical policy guidelines, and other documents/information. Support the FWA Program's short and long-term goals, as developed by Management, to prevent, detect, and correct issues of fraud, waste, and abuse. Review the FWA Program's policies and procedures, guidelines, practices, templates, and tools and make recommendations for revisions, as identified. Identify potential risks, non-compliance and/or alleged violations within the Plan or with external partners and issue root cause analysis/corrective action plans, as appropriate. Collaborate with internal partners on FWA intelligence and initiatives and assist with tracking and trending to identify potential fraud, waste, and abuse. Coordinate with Compliance Auditors as it relates to FWA issues and help implement process improvement measures to prevent, correct, and mitigate those risks in the future. Perform any other duties as assigned to ensure Plan operations are successful. Qualifications Education & Requirements Four (4) or more years relevant professional experience in a health care environment, with an emphasis in fraud, waste, and abuse investigations, including Federal and State reporting requirements Experience in health care fraud investigation, detection, and/or healthcare related specialty including but limited to; Pharmacy, DEM, Mental Health, Behavioral Health, Hospice, Home Health, claims, or claims processing preferred Bachelor's degree from an accredited institution In lieu of the required degree, a minimum of four (4) years of additional relevant work experience is required for this position This experience is in addition to the minimum years listed in the Experience Requirements above Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), or similar certification/licensure preferred Key Qualifications Strong knowledge of Managed Care, Medi-Cal, and Medicare programs as well as Marketplace Compliance program principles and practices of managed care. Knowledge of federal and state guidelines as well as ICD, CPT, HCPCS, coding Excellent verbal and written communication skills with thorough documentation, composing detailed investigative reports and professional internal and external correspondence Interpersonal and presentation skills to communicate with internal departments and external agencies Demonstrated analytical, problem solving, and resolution skills Strong organizational skills and attention to detail. Proficiency in Microsoft Office programs including, but not limited to: Word, Excel, PowerPoint, Outlook, and Access Demonstrated proficiency in data mining and the use of data analytics to detect fraud, waste, and abuse, including the utilization of pivot tables, formulas, and trending Proven ability to: Work independently and collaboratively within a team environment. Apply knowledge, and address situations appropriately with minimal guidance Manage multiple projects with competing deadlines and changing priorities Research, comprehend and interpret various state specific Medicaid, Federal Medicare, and ACA/Exchange laws, rules and guidelines Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach Minimal physical activity; may include standing, walking, sitting lifting, and pushing and carrying up to 25 lbs Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location This position is on a hybrid work schedule. (Mon & Fri - remote, Tues - Thurs onsite in Rancho Cucamonga, CA) Pay Range USD $80,059.20 - USD $106,059.20 /Yr.

Come work at a place where innovation and teamwork come together to support the most exciting missions in the world! Job Title: Subrogation Investigator Cost Center: 682891012 SHP-Legal-Subrogation Scheduled Weekly Hours: 40 Employee Type: Regular Work Shift: 40 Normal (United States of America) Job Description: JOB SUMMARY Identify and investigate potential subrogation situations. Work in conjunction with various entities to obtain accident and injury information. Utilize subrogation software to create accounts, log case details, and update account status. JOB QUALIFICATIONS Education Education qualifications must be from a school whose accreditation is recognized by Marshfield Clinic. Required Education: Satisfactory completion of continuing education courses to include medical terminology and coding to be completed within one year of hire. Preferred Education: College or technical school courses with emphasis on business, legal, or medical. Experience Minimum Experience Required: Two years previous work experience in collections, legal, claims processing, or subrogation related field. Preferred/Optional Experience: Marshfield Clinic Health System is committed to enriching the lives of others through accessible, affordable and compassionate healthcare. Successful applicants will listen, serve and put the needs of patients and customers first. Exclusion From Federal Programs: Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Health System's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program. Marshfield Clinic Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members. Researches, gathers, and analyzes data to identify trends, patterns, aberrancies, and outliers in provider billing behavior. Serves as a subject matter expert for other investigators. Qualified candidates must live in Massachusetts or surrounding states. Essential Functions: Develop, coordinate and conduct strategic fact-driven investigative projects including business process review, execution of investigative activities, and development of investigation outcome recommendations Manage the development, production, and validation of reports generated from detailed claims, eligibility, pharmacy, and clinical data and translate analytical findings into actionable items Manage strategic investigative plan and drive investigative outcome for the team Ensure quality outcomes for investigative team through auditing and oversight Prioritize, track, and report status of investigations Report identified corporate financial impact issues Use concepts and knowledge of coding guidelines to analyze complex provider claim submissions Research, comprehend and interpret various state specific Medicaid, federal Medicare, and ACA/Exchange laws, rules and guidelines Identify, research and comprehend medical standards, healthcare authoritative sources and apply knowledge to investigative approach Collaborate with data analytics team and utilize RAT STATS on Statistically Valid Random Sampling Coordinate and conduct on-site and desk audits of medical record reviews and claim audits Manage and decision claims pended for investigative purposes Maintain a working knowledge of all state and federal laws, rules, and billing guidelines for various provider specialty types Prepare and conduct in-depth complex interviews relevant to investigative plan Execute and manage provider formal corrective action plans Participate in meetings with operational departments, business partners, and regulatory partners to facilitate investigative case development Participate in meetings with Legal General Counsel to drive case legal actions, formal corrective actions, negotiations with recovery efforts, settlement agreements, and preparation of evidentiary documents for litigation Present, support, and defend investigative research to seek approval for formal corrective actions Establish and maintain relationships with Federal and State law enforcement agencies, task force members, other company SIU staff and external contacts involved in fraud investigation, detection and prevention SME in the designated market and ability to apply external intelligence to their analysis and case development Develop and present internal and external formal presentations, as needed Attend fraud, waste, and abuse training/conferences, as needed Support regulatory fraud, waste, and abuse reports to federal and state Medicare/Medicaid agencies Manage and maintain sensitive confidential investigative information Maintain compliance with state and federal laws and regulations and contracts Adhere to the CareSource Corporate Compliance Plan and the Anti-Fraud Plan Assist in Federal and State regulatory audits, as needed Perform any other job-related instructions, as requested Education and Experience: Bachelor's Degree or equivalent years of relevant work experience in Health-Related Field, Law Enforcement, or Insurance required Master's Degree (e.g., criminal justice, public health, mathematics, statistics, health economics, nursing) preferred Minimum of five (5) years of experience in healthcare fraud investigations, medical coding, pharmacy, medical research, auditing, data analytics or related field is required Competencies, Knowledge and Skills: Intermediate proficiency level in Microsoft Office to include Outlook, Word, Excel, Access, and PowerPoint Effective listening and critical thinking skills and the ability to identify gaps in logic Strong interpersonal skills, high level of professionalism, integrity and ethics in performance of all duties Excellent problem solving and decision making skills with attention to details Background in research and drawing conclusions Ability to perform intermediate data analysis and to articulate understanding of findings Ability to work under limited supervision with moderate latitude for initiative and independent judgment Ability to manage demanding investigative case load Ability to develop, prioritize and accomplish goals Self-motivated, self-directed Strong written skills with ability to compose detailed investigative reports and professional internal and external correspondences Presentation experience, beneficial Knowledge of Medicaid, Medicare, healthcare rules preferred Background in medical terminology, CPT, HCPCS, ICD codes or medical billing preferred Complex project management skills preferred Display leadership qualities Licensure and Certification: One of the following certifications is required: Accredited Healthcare Fraud Investigator (AHFI) or Certified Fraud Examiner (CFE) Certified Professional Coder (CPC) is preferred NHCAA or other fraud and abuse investigation training is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time Occasional travel (up to 10%) to attend meetings, training, and conferences may be required Compensation Range: $70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-SD1

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Flexible for any of our NC office locations (Must live in NC or within 40 miles of NC border) Projected Hiring Range : Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position will assist in the development, implementation, revision, maintenance, and promotion of the agency's fraud, waste, and abuse prevention and detection activities to ensure that the agency and the agency's network operates in a manner that complies with applicable State and Federal laws, regulations, agency policies, national accreditation, and Medicaid guidelines. This position will perform functions relating to data analysis, investigations, and auditing relating to the monitoring, detection, and resolution of healthcare fraud, waste, and abuse. Role and Responsibilities: Conduct, plan and perform independent and comprehensive audits, investigations and reviews (hereinafter referred to as investigations) into allegations of regulatory compliance violations, including fraud, waste, and abuse (FWA). Investigation includes the review of financial, consumer/clinical, provider, and/or other records, reports, and information necessary to thoroughly analyze and investigate suspected violations. Conduct clinical and non-clinical interviews, as necessary, to facilitate the investigative process. Work collaboratively with appropriate internal/external subject matter experts, agency and provider personnel, as necessary, to facilitate the investigative process. Conducts clinical chart reviews of instances of care authorized for utilization purposes, case reviews for individuals that are identified as either over or under-utilizers of services. Knowledge of documentation and clinical protocols for utilization purposes and case reviews for individual consumers in order to conduct clinical chart reviews. Clinical knowledge of managed systems of physical health services (professional and institutional), durable medical equipment, pharmacy, Mental Health, substance abuse, and Intellectual and Developmental Disabilities to also include co-occurring disorders. Knowledge of managed care practices and principles to detect fraud, waste and abuse. Clinical ability to recognize gaps in Partners Health Management service network and ability to communicate these identified gaps to appropriate parties. Serve as a Lead Investigator responsible for coordinating and leading agency investigative teams related to program integrity. Gather, evaluate, and synthesize evidence related to reported allegations to determine compliance with applicable state and federal policies, laws, and regulations. Prepare written and oral reports based on the results of assigned work that help to sustain findings and uphold disputed TNOs. Prepare timely, thorough, and accurate investigative reports; compile case file documentation; calculate overpayments; and synthesize findings in accordance with agency policies and procedures and departmental guidelines. Communicate effectively, both in writing and orally, to ensure accurate and timely completion of all assignments. Develop, implement, monitor, and maintain analytic reports to detect and prevent health care FWA. Conduct independent data mining and data analysis techniques utilizing claims data to detect abnormal claims and develop trends and patterns for potential cases. Independently prepare case documents for referral to the appropriate oversight agency and other external agencies involved in the prosecution of health care fraud. Manage cases from complaint intake through their ultimate conclusion, including supporting the case during all legal processes and appeals and the collection of final overpayments. Create, maintain, and manage cases within the case filing and tracking systems to ensure information is accurate, timely and complete. Consult with legal counsel in order to prepare testimony and other information necessary for appeals and as requested by external agencies investigating or prosecuting Medicaid fraud (as appropriate). Remain abreast of all federal and North Carolina rules and laws applicable to FWA and program integrity. Develop and conduct proactive audits, reviews and investigations of Partners' programs to facilitate the detection and resolution of FWA. Develop, coordinate, and facilitate educational training to the Provider Network and agency personnel on issues relating to the compliance program, FWA. Identify information system edits/alerts/reports in need of implementation in the claims processing system(s). Recommend and implement compliance initiatives, policies, procedures, and practices designed to promote and encourage the reporting of suspected FWA without fear of retaliation. Serve on and/or facilitate various agency committees as deemed necessary by the Program Integrity Director Use data collection instruments and protocols previously developed or adopted by the department and develop data collection instruments as needed for complex investigations. Analyze computer-generated data sets, including claims data, to identify individuals and organizations that are most likely to provide evidence to ascertain whether FWA is likely to have occurred. Develop summary reports that illustrate data analysis to a nonscientific audience. Use appropriate software and systems to complete work assignments. Consult with IT to manage data and generate needed program reports. Perform other duties as assigned. Knowledge, Skills and Abilities: Strong knowledge of state and federal laws, including those related to Medicaid FWA, and regulatory compliance are required. Knowledge of investigative methods and procedures. Knowledge of claims processing and clinical services. Excellent interpersonal and communication skills. Excellent analytical skills. Effective time management and organizational skills. Excellent conflict management skills. Proficient in Word, Excel, Outlook, and Power Point. Ability to learn and effectively manage various information systems including Partners' claims reporting and North Carolina TRACKS. Ability to develop solutions and make recommendations for necessary process improvements. Ability to interpret contractual agreements, business oriented statistics, clinical/administrative services and records. A high level of integrity and discretion is required to effectively carry out the responsibilities related to this position. Education and Experience Required: Master's degree in a Human Services field, Health Administration, health informatics/analytics, or related field, OR a Bachelor's of Science in Nursing and licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing. Minimum of 3 years recent experience in the healthcare field with compliance monitoring, auditing or investigation experience. Licensed Clinical Social Worker, Licensed Clinical Mental Health Counselor, Licensed Clinical Addiction Specialist, Registered Nurse, Nurse Practitioner, Physician's Assistant, or another clinical license related to the healthcare field. Education and Experience Preferred: Five years recent experience in the healthcare field. Experience analyzing complex data, claims processing, utilization reviews, provider credentialing/monitoring, and/or fraud and abuse detection. Preferred credentials: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Specialist (CCS); Certified Fraud Examiner (CFE); and/or Accredited Healthcare Fraud Investigator (AHFI) certification. Licensure/Certification Requirements: Current unrestricted LCSW, LCMHC, LPA, LMFT or LCAS licensure with the appropriate professional board of licensure in the state of North Carolina or licensed to practice as a Registered Nurse, Nurse Practitioner in North Carolina by the N. C. Board of Nursing or licensure in the State of North Carolina or licensed to practice as a Physician's Assistant by the North Carolina Medical Board. Employee is responsible for complying with respective licensure board's continuing education/ training requirements in order to maintain an active license. Must maintain licensure or certification.

Competitive Compensation & Benefits Package! eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs Public Service Loan Forgiveness Qualifying Employer See attachment for additional details. Office Location: Flexible for any of our NC office locations (Must live in NC or within 40 miles of NC border) Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position will assist in the development, implementation, revision, maintenance, and promotion of the agency's fraud, waste, and abuse prevention and detection activities to ensure that the agency and the agency's network operates in a manner that complies with applicable State and Federal laws, regulations, agency policies, national accreditation, and Medicaid guidelines. This position will perform functions relating to data analysis, investigations, and auditing relating to the monitoring, detection, and resolution of healthcare fraud, waste, and abuse. Role and Responsibilities: Conduct, plan and perform independent and comprehensive audits, investigations and reviews (hereinafter referred to as investigations) into allegations of regulatory compliance violations, including fraud, waste, and abuse (FWA). Investigation includes the review of financial, consumer/clinical, provider, and/or other records, reports, and information necessary to thoroughly analyze and investigate suspected violations. Conduct clinical and non-clinical interviews, as necessary, to facilitate the investigative process. Work collaboratively with appropriate internal/external subject matter experts, agency and provider personnel, as necessary, to facilitate the investigative process. Conducts clinical chart reviews of instances of care authorized for utilization purposes, case reviews for individuals that are identified as either over or under-utilizers of services. Knowledge of documentation and clinical protocols for utilization purposes and case reviews for individual consumers in order to conduct clinical chart reviews. Clinical knowledge of managed systems of physical health services (professional and institutional), durable medical equipment, pharmacy, Mental Health, substance abuse, and Intellectual and Developmental Disabilities to also include co-occurring disorders. Knowledge of managed care practices and principles to detect fraud, waste and abuse. Clinical ability to recognize gaps in Partners Health Management service network and ability to communicate these identified gaps to appropriate parties. Serve as a Lead Investigator responsible for coordinating and leading agency investigative teams related to program integrity. Gather, evaluate, and synthesize evidence related to reported allegations to determine compliance with applicable state and federal policies, laws, and regulations. Prepare written and oral reports based on the results of assigned work that help to sustain findings and uphold disputed TNOs. Prepare timely, thorough, and accurate investigative reports; compile case file documentation; calculate overpayments; and synthesize findings in accordance with agency policies and procedures and departmental guidelines. Communicate effectively, both in writing and orally, to ensure accurate and timely completion of all assignments. Develop, implement, monitor, and maintain analytic reports to detect and prevent health care FWA. Conduct independent data mining and data analysis techniques utilizing claims data to detect abnormal claims and develop trends and patterns for potential cases. Independently prepare case documents for referral to the appropriate oversight agency and other external agencies involved in the prosecution of health care fraud. Manage cases from complaint intake through their ultimate conclusion, including supporting the case during all legal processes and appeals and the collection of final overpayments. Create, maintain, and manage cases within the case filing and tracking systems to ensure information is accurate, timely and complete. Consult with legal counsel in order to prepare testimony and other information necessary for appeals and as requested by external agencies investigating or prosecuting Medicaid fraud (as appropriate). Remain abreast of all federal and North Carolina rules and laws applicable to FWA and program integrity. Develop and conduct proactive audits, reviews and investigations of Partners' programs to facilitate the detection and resolution of FWA. Develop, coordinate, and facilitate educational training to the Provider Network and agency personnel on issues relating to the compliance program, FWA. Identify information system edits/alerts/reports in need of implementation in the claims processing system(s). Recommend and implement compliance initiatives, policies, procedures, and practices designed to promote and encourage the reporting of suspected FWA without fear of retaliation. Serve on and/or facilitate various agency committees as deemed necessary by the Program Integrity Director Use data collection instruments and protocols previously developed or adopted by the department and develop data collection instruments as needed for complex investigations. Analyze computer-generated data sets, including claims data, to identify individuals and organizations that are most likely to provide evidence to ascertain whether FWA is likely to have occurred. Develop summary reports that illustrate data analysis to a nonscientific audience. Use appropriate software and systems to complete work assignments. Consult with IT to manage data and generate needed program reports. Perform other duties as assigned. Knowledge, Skills and Abilities: Strong knowledge of state and federal laws, including those related to Medicaid FWA, and regulatory compliance are required. Knowledge of investigative methods and procedures. Knowledge of claims processing and clinical services. Excellent interpersonal and communication skills. Excellent analytical skills. Effective time management and organizational skills. Excellent conflict management skills. Proficient in Word, Excel, Outlook, and Power Point. Ability to learn and effectively manage various information systems including Partners' claims reporting and North Carolina TRACKS. Ability to develop solutions and make recommendations for necessary process improvements. Ability to interpret contractual agreements, business oriented statistics, clinical/administrative services and records. A high level of integrity and discretion is required to effectively carry out the responsibilities related to this position. Education and Experience Required: Master's degree in a Human Services field, Health Administration, health informatics/analytics, or related field, OR a Bachelor's of Science in Nursing and licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing. Minimum of 3 years recent experience in the healthcare field with compliance monitoring, auditing or investigation experience. Licensed Clinical Social Worker, Licensed Clinical Mental Health Counselor, Licensed Clinical Addiction Specialist, Registered Nurse, Nurse Practitioner, Physician's Assistant, or another clinical license related to the healthcare field. Education and Experience Preferred: Five years recent experience in the healthcare field. Experience analyzing complex data, claims processing, utilization reviews, provider credentialing/monitoring, and/or fraud and abuse detection. Preferred credentials: Registered Health Information Technician (RHIT); Registered Health Information Administrator (RHIA); Certified Coding Specialist (CCS); Certified Fraud Examiner (CFE); and/or Accredited Healthcare Fraud Investigator (AHFI) certification. Licensure/Certification Requirements: Current unrestricted LCSW, LCMHC, LPA, LMFT or LCAS licensure with the appropriate professional board of licensure in the state of North Carolina or licensed to practice as a Registered Nurse, Nurse Practitioner in North Carolina by the N. C. Board of Nursing or licensure in the State of North Carolina or licensed to practice as a Physician's Assistant by the North Carolina Medical Board. Employee is responsible for complying with respective licensure board's continuing education/ training requirements in order to maintain an active license. Must maintain licensure or certification.

Ohio Department of Public Safety - Bureau of Motor Vehicles/Investigations District 4 Toledo Report in Location: 1 Maritime Plaza, Toledo, OH 43604 Work Hours: Monday - Friday, 8:00 a.m. - 5:00 p.m. Perks of Working for the Ohio Department of Public Safety * Multiple pay increases over the first years of service! * Free Parking! What You'll Do as a BMV Investigator * Independently, or as a lead investigator, conduct criminal investigations related to allegations of fraud, abuse or other violations of ORC, OAC & BMV policy, file criminal charges & enforce Ohio motor vehicle laws & agency guidelines: * Investigate criminal acts (e.g., odometer tampering, forgeries & falsifications, possession of criminal tools, selling motor vehicles without a license, illegally obtained driver licenses, license plates, vehicle registrations & handicap parking permits); * Enforce Ohio motor vehicle laws & agency guidelines; * Locate & contact individuals whose driving &/or registration privileges have been suspended, confiscate driver licenses &/or license plates, interview individuals; * Perform investigations concerning hardship driver license &/or medical restriction cases & submit recommendations; * Participate with law enforcement & other government agencies in investigations & criminal prosecution of violators of motor vehicle laws (e.g., consult with prosecutors, file charges, present investigative case reports as a witness before the Dealer Board & testify in court). Click here to see the full position description Option 1 24 mos. exp. as law enforcement officer; AND valid driver's license. Option 2 * Or completion of associate core program in criminology, criminal justice or law enforcement; AND 18 months experience in conducting criminal investigations. (Note: conducting criminal investigations is defined as performing field interviews & interrogation, field surveillance, field information& evidence gathering techniques while conducting investigations involving violations of criminal law(i.e., special emphasis on theft& fraud cases) as well as researching various administrative laws, policies & procedures related to commission of possible criminal offenses); AND valid driver's license. Option 3 * Or 24 months experience as a Motor Vehicle Investigator Associate, 24320; AND valid driver's license. * Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Pursuant to Ohio Administrative Code Chapter 4501 users of system shall adhere to policies& guidelines published in NCIC operating manual, CJIS security policy, LEADS operating manual, LEADS security policy, newsletters, & administrative messages from LEADS, all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS, state& national fingerprint-based record checks must be conducted within 30 days of initial employment or assignment of all personnel, having access to LEADS, or to records storage areas containing CCH data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including, but not limited to: an applicant fingerprint card submission to BCI &I & FBI, an inquiry of state& national arrest& fugitive files; terminal agency is required to notify CTO of any applicant's criminal record; existence of a criminal record may result in denial of access. Helpful Tips for Applying: 1. Be detailed when describing your current/previous work duties. The more the better!! Don't just write "see attached resume". 2. Tailor your application for each position you apply for. You should clearly describe how you meet the minimum qualifications outlined in this job posting. 3. Respond to all questions asked. If you do not have the education/training/experience that is being asked, select either "No" or "N/A". Job Skills: Investigation

The Investigator plays an important part at the Board. In this role, you will be responsible for: * Conducting investigations of complaints and alleged violations of the Ohio Revised Code 4732/4783 and the Ohio Administrative Code 4732/4783. * Interviewing complainants, witnesses, public members, licensees subject to allegations and unlicensed individuals who may be practicing illegally or using titles, terminology and/or techniques restricted by law. * Preparing reports and making recommendations regarding investigation strategy, case status. * Interpreting application of administrative rules, Ohio Revised Code, ethical principles and Psychology Board policy and procedures. * Responding to inquiries from citizens regarding complex and sensitive material related to confidentiality, client rights, mental disorders and occupational standards of care in psychology. * Drafting legal correspondence and documents including case notes, reports, subpoenas, letters, notice of opportunity for hearing letters, consent agreements and adjudication orders. * Preparing confidential investigation reports and recommendations. * Maintaining files and records and conferring with legal personnel. * Requesting and serving Psychology Board subpoenas. * Testifying in administrative hearings on behalf of the Psychology Board and/or criminal hearings on behalf of the Board. * Handling sensitive inquiries received via telephone, in writing, or in person from psychology physicians, legal counsel, consumers and the general public. * Assisting in development of Psychology Board investigative policies, procedures and methods in accordance with related civil service laws. * Entering and maintaining case information in Psychology Board's investigative case tracking database. * Attending and participating in law enforcement seminars and training and serving on committees and task forces. 30 months of training or 30 months of investigative experience with experience corresponding to type of complaints & alleged violations appearing in job posting/approved position description AND valid driver's license. * OR Completion of associate core program in law enforcement, criminal justice or in academic field commensurate with program area to be assigned per approved Position Description on file AND 12 months of experience conducting investigations and/or inspections AND valid driver's license. * OR 30 months of training or 30 months of experience as Investigator Assistant, 26210 with experience corresponding to type of complaints & alleged violations appearing in job posting/approved position description AND valid driver's license. * OR equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: Investigation

The San Francisco Police Department was established in 1849 and continually strives to become a more effective, inclusive and modern police department, while earning the trust and pride of those we serve and those who serve. Our goal is to reflect on current SFPD initiatives, assess best practices across the country, and evaluate the changing environment in policing and within the City to arrive at a strategy statement that the Department and our community can embody every day. The San Francisco Police Department stands for Safety and Respect for All. We will engage in just transparent unbiased and responsive policing. We will do so in the spirit of dignity and in collaboration with the community. And we will maintain and build trust and respect as the guardians of Constitutional and human rights. The San Francisco Police Department is committed to excellence in law enforcement and is dedicated to the people, traditions and diversity of our City. The department provides service with understanding, response with compassion, performance with integrity and law enforcement with vision. The department has grown into a nationally known police department providing law enforcement services to one of the most recognized cities in the United States. Specific information regarding this recruitment process are listed below: Application Opening: May 28, 2025 Application Deadline: Apply immediately, announcement may close anytime after two weeks from posting date. Class & Compensation: $112,112 - $136,240 Recruitment ID: TEX-1251-157333 Appointment Type: Temporary Exempt - This position is excluded by the Charter from the competitive Civil Service examination process and shall serve at the discretion of the Appointing Officer. The duration of the appointment shall not exceed 36 months. Work Location: SFPD Headquarters, 1245 3rd Street, San Francisco, CA 94158 Job Description Under general direction, coordinates, directs and conducts background investigations for candidates under consideration for employment. Incumbents in this class are considered journey level investigators who may function independently or as a member of a team. Example of Important and Essential Duties: The duties specified below are representative of the range of duties assigned to this job code/class and are not intended to be an inclusive list. Reviews applications for completeness and directs candidates to provide additional information if needed; obtains proper information release documents. Conducts background interviews with candidates to review and collect required documentation; confirms candidates meet the minimum qualifications of the job classification. Conducts background investigation using tact and discretion; confirms information provided by candidates; makes inquiries to assist in determining credibility of statements; interviews references, including family, personal to include law enforcement and gathers evidence in order to provide a body of information for analysis; reviews local, state, and federal criminal databases; may conduct home visits and/or neighborhood checks which can include travel to locations outside of the county and/or outside of the state as necessary. Conducts follow-up investigations regarding any negative information or discrepancies; conducts discrepancy interviews. Summarizes and explains progress and results of investigations with applicants and/or supervisor. Regularly prepares lists and records accounting for status of assigned investigative caseload. Maintains records, files, data and supporting documentation for each case handled; preserves evidence in a secure manner for evaluation and analysis; adherence to established customs and procedures regarding control and custody of records, including evidence. Analyzes information and evidence resulting from investigative activities drawing logical and objective conclusions; prepares written background investigation reports; confers with hiring managers; makes recommendations regarding suitability for employment. Qualifications 1. Possession of a baccalaureate degree from an accredited college or university; 2. Two (2) years full-time equivalent experience performing employment investigative work in a government or contract investigative agency; AND 3. Possession of a valid California driver license. Substitution: Two (2) years full- time equivalent experience performing criminal investigatory case work which involves suspects or actual violations of criminal laws, rules, regulations within an Investigations Division/Bureau with a Law Enforcement agency may substitute for the required employment work experience outlined above. Additional experience as described above may substitute for the required degree on a year-for-year basis. One (1) year is equivalent to thirty (30) semester units / forty-five (45) quarter units. Desirable Qualifications: Law enforcement agency experience Knowledge of MS applications (Excel, Word, PowerPoint, etc.) Exceptional interpersonal, oral, and written communication skills Verification of Education and Experience: Applicants may be required to submit verification of qualifying education and experience at any point during the recruitment and selection process. If education verification is required, information on how to verify education requirements, including verifying foreign education credits or degree equivalency, can be found at *************************************************** Note: Falsifying one's education, training, or work experience or attempted deception on the application may result in disqualification for this and future job opportunities with the City and County of San Francisco. All work experience, education, training and other information substantiating how you meet the minimum qualifications must be included on your application by the filing deadline. Information submitted after the filing deadline will not be considered in determining whether you meet the minimum qualifications. Resumes will not be accepted in lieu of a completed City and County of San Francisco application. Applications completed improperly may be cause for ineligibility or disqualification. Background Investigation: Prior to employment with the San Francisco Police Department, a thorough background investigation will be conducted to determine the candidate's suitability for employment. The investigation may include, but not be limited to: criminal history records, driving records, drug/alcohol screening, and other related employment and personal history records. Reasons for rejection may include use of controlled substances and alcohol, felony conviction, repeated or serious violations of the law, inability to work with co-workers, inability to accept supervision, inability to follow rules and regulations or other relevant factors. Candidates may be required to undergo drug/alcohol screening, and must clear Department of Justice and Federal Bureau of Investigation fingerprinting. Criminal records will be carefully reviewed; candidates who do not report their complete criminal records on their applications will be disqualified. Applicants will be fingerprinted. Additional Information Recruiter Information : If you have any questions regarding this recruitment or application process, please contact the Sr. Human Resources Analyst, Anna Duong at [email protected] . Additional Information Regarding Employment with the City and County of San Francisco: Information About The Hiring Process Conviction History Employee Benefits Overview Equal Employment Opportunity Disaster Service Worker ADA Accommodation Right to Work Copies of Application Documents Diversity Statement SFPD Recruitment: **************************************************** The City and County of San Francisco encourages women, minorities and persons with disabilities to apply. Applicants will be considered regardless of their sex, race, age, religion, color, national origin, ancestry, physical disability, mental disability, medical condition (associated with cancer, a history of cancer, or genetic characteristics), HIV/AIDS status, genetic information, marital status, sexual orientation, gender, gender identity, gender expression, military and veteran status, or other protected category under the law.

Located in Milwaukee, Wisconsin, the Versiti Blood Research Institute (VBRI) is the largest blood-focused research institute in the United States. With over 30 basic, translational, and clinical researchers, the institute is dedicated to advancing scientific knowledge and developing innovative therapies related to blood and blood disorders. The institute's research interests encompass a wide range of topics, including transfusion medicine, cellular therapy, thrombosis/hemostasis, immunology, and hematologic malignancies. As a vital part of Versiti, a non-profit organization with a blood bank at its core, the VBRI strives to improve lives through innovative research and the development of novel diagnostics and treatments. VBRI is part of the Milwaukee Regional Medical Campus, a rapidly growing clinical-translational research hub. VBRI's proximity to the Medical College of Wisconsin, Childrens' Hospital of Wisconsin, and Froedtert Hospital facilitates seamless interdisciplinary collaborations. A range of exemplary core facilities support highly competitive research. In the summer of 2024, construction of a new research building will start, doubling existing VBRI research space to enable the recruitment of 10-15 new faculty. With its renowned researchers, strategic expansion plans and location in a highly collaborative environment, the VBRI is poised to maintain and expand its position as one of the leading hematology institutes in the world. Position Summary Transfusion Medicine Faculty Positions in Basic and/or Translational Research We seek to grow our Transfusion Medicine, Vascular Biology and Cell Therapy Program by recruiting innovative investigators with research interests in transfusion medicine and related fields such as cell therapy, gene therapy, glycobiology, and vascular biology. Applicants at all academic ranks with Ph.D., M.D., or equivalent degrees are encouraged to apply. Ideal candidates will develop or maintain independently funded basic and/or translational research programs. For physician-scientists, clinical transfusion medicine duties (up to 20% effort) may include blood bank oversight, transfusion consultations, therapeutic apheresis, and quality assurance activities. These positions provide attractive start-up packages and outstanding opportunities for collaboration with basic, translational, and clinical investigators. The VBRI is located on the same campus as the Medical College of Wisconsin (MCW), Children's Hospital of Wisconsin, and Froedtert Hospital, which facilitates collaboration, provides additional research breadth, and enables access to graduate students. VBRI faculty typically hold an appointment at MCW, including clinical departments, to facilitate translational research. Total Rewards Package Benefits Versiti provides a comprehensive benefits package based on your job classification. Full-time regular employes are eligible for Medical, Dental, and Vision Plans, Paid Time Off (PTO) and Holidays, Short- and Long-term disability, life insurance, 7% match dollar for dollar 401(k), voluntary programs, discount programs, others. Responsibilities Why Join the Versiti Blood Research Institute? The Versiti Blood Research Institute (VBRI), located in Milwaukee, Wisconsin, is focused on innovative blood and vascular research. The VBRI provides a unique academic environment, reflected by its long record of scientific excellence and innovation since its founding over seventy years ago. The VBRI is strategically strengthening its programs to promote both mechanistic and clinical-translational science. We are committed to impactful, rigorous science that can change lives. The VBRI currently houses 31 principal investigators in four Programs: Thrombosis and Hemostasis; Transfusion Medicine, Vascular Biology and Cell Therapy; Hematopoiesis; and Immunohematology. The VBRI has started a significant expansion of its research capacity with plans for adding 14 new principal investigators in the next 5 to 7 years. Designs for a new 60,000 - 80,000 ft 2 research building are under development with completion anticipated in 2026. The VBRI is part of Versiti, a not-for-profit organization focused on all aspects of hematology, including diagnostic testing, supply of blood products, and leading-edge basic, clinical, and translational research. A founding principle of Versiti is transfusion medicine research, and we have a long history of groundbreaking discoveries, including over 20 years of participation in the NHLBI-funded Recipient Epidemiology and Donor Evaluation Study (REDS) program. Qualifications Who are we looking for? Eligible candidates will have a Ph.D. and/or M.D. or equivalent doctoral degree. Successful candidates will have track records of creativity and productivity, a desire to integrate into our dynamic, collaborative, and rapidly expanding research community, and a commitment to our core values of equity, diversity, and inclusion. Successful candidates are expected to develop an innovative research program, obtain extramural funding, and participate actively in education, training, and mentorship. How do you apply? Qualified applicants should submit a single pdf containing a cover letter and CV, along with a summary of research accomplishments and future research plans (four pages maximum). Request up to four letters of recommendation be sent to *************************. Versiti is committed to increasing the diversity of its faculty and strongly encourages applications from individuals in groups that are underrepresented in the biomedical sciences such as candidates from rural areas. The VBRI will attract and retain a workforce and faculty that reflects the community we serve. Versiti is an equal opportunity employer. Milwaukee|milwaukee.org. Located on the west side of beautiful Lake Michigan in Wisconsin, Milwaukee is a well-kept secret of affordable quality of life. The city boasts a range of museums, some of the nation's largest summer festivals, a multi-cultural population rich in culinary and artistic tradition, a progressive downtown area, and many outdoor recreation opportunities, including plenty of parks, river walks, and public beaches. Housing is affordable, public and parochial schools are excellent, and traffic is a breeze. Milwaukee neighborhoods are known for variety, character, and unique architecture, offering superb quality of life and exceptional work-life balance in a city rife with history. With Chicago only 75 minutes away, world-class cultural and sporting venues and one of the world's busiest air travel hubs are within easy reach. #LI-EH1 #LI-Onsite #VBRI

Located in Milwaukee, Wisconsin, the Versiti Blood Research Institute (VBRI) is the largest blood-focused research institute in the United States. With over 30 basic, translational, and clinical researchers, the institute is dedicated to advancing scientific knowledge and developing innovative therapies related to blood and blood disorders. The institute's research interests encompass a wide range of topics, including transfusion medicine, cellular therapy, thrombosis/hemostasis, immunology, and hematologic malignancies. As a vital part of Versiti, a non-profit organization with a blood bank at its core, the VBRI strives to improve lives through innovative research and the development of novel diagnostics and treatments. VBRI is part of the Milwaukee Regional Medical Campus, a rapidly growing clinical-translational research hub. VBRI's proximity to the Medical College of Wisconsin, Childrens' Hospital of Wisconsin, and Froedtert Hospital facilitates seamless interdisciplinary collaborations. A range of exemplary core facilities support highly competitive research. In the summer of 2024, construction of a new research building will start, doubling existing VBRI research space to enable the recruitment of 10-15 new faculty. With its renowned researchers, strategic expansion plans and location in a highly collaborative environment, the VBRI is poised to maintain and expand its position as one of the leading hematology institutes in the world. Position Summary Transfusion Medicine Faculty Positions in Basic and/or Translational Research We seek to grow our Transfusion Medicine, Vascular Biology and Cell Therapy Program by recruiting innovative investigators with research interests in transfusion medicine and related fields such as cell therapy, gene therapy, glycobiology, and vascular biology. Applicants at all academic ranks with Ph.D., M.D., or equivalent degrees are encouraged to apply. Ideal candidates will develop or maintain independently funded basic and/or translational research programs. For physician-scientists, clinical transfusion medicine duties (up to 20% effort) may include blood bank oversight, transfusion consultations, therapeutic apheresis, and quality assurance activities. These positions provide attractive start-up packages and outstanding opportunities for collaboration with basic, translational, and clinical investigators. The VBRI is located on the same campus as the Medical College of Wisconsin (MCW), Children's Hospital of Wisconsin, and Froedtert Hospital, which facilitates collaboration, provides additional research breadth, and enables access to graduate students. VBRI faculty typically hold an appointment at MCW, including clinical departments, to facilitate translational research. Total Rewards Package Benefits Versiti provides a comprehensive benefits package based on your job classification. Full-time regular employes are eligible for Medical, Dental, and Vision Plans, Paid Time Off (PTO) and Holidays, Short- and Long-term disability, life insurance, 7% match dollar for dollar 401(k), voluntary programs, discount programs, others. Responsibilities Why Join the Versiti Blood Research Institute? The Versiti Blood Research Institute (VBRI), located in Milwaukee, Wisconsin, is focused on innovative blood and vascular research. The VBRI provides a unique academic environment, reflected by its long record of scientific excellence and innovation since its founding over seventy years ago. The VBRI is strategically strengthening its programs to promote both mechanistic and clinical-translational science. We are committed to impactful, rigorous science that can change lives. The VBRI currently houses 31 principal investigators in four Programs: Thrombosis and Hemostasis; Transfusion Medicine, Vascular Biology and Cell Therapy; Hematopoiesis; and Immunohematology. The VBRI has started a significant expansion of its research capacity with plans for adding 14 new principal investigators in the next 5 to 7 years. Designs for a new 60,000 - 80,000 ft 2 research building are under development with completion anticipated in 2026. The VBRI is part of Versiti, a not-for-profit organization focused on all aspects of hematology, including diagnostic testing, supply of blood products, and leading-edge basic, clinical, and translational research. A founding principle of Versiti is transfusion medicine research, and we have a long history of groundbreaking discoveries, including over 20 years of participation in the NHLBI-funded Recipient Epidemiology and Donor Evaluation Study (REDS) program. Qualifications Who are we looking for? Eligible candidates will have a Ph.D. and/or M.D. or equivalent doctoral degree. Successful candidates will have track records of creativity and productivity, a desire to integrate into our dynamic, collaborative, and rapidly expanding research community, and a commitment to our core values of equity, diversity, and inclusion. Successful candidates are expected to develop an innovative research program, obtain extramural funding, and participate actively in education, training, and mentorship. How do you apply? Qualified applicants should submit a single pdf containing a cover letter and CV, along with a summary of research accomplishments and future research plans (four pages maximum). Request up to four letters of recommendation be sent to *************************. Versiti is committed to increasing the diversity of its faculty and strongly encourages applications from individuals in groups that are underrepresented in the biomedical sciences such as candidates from rural areas. The VBRI will attract and retain a workforce and faculty that reflects the community we serve. Versiti is an equal opportunity employer. Milwaukee|milwaukee.org. Located on the west side of beautiful Lake Michigan in Wisconsin, Milwaukee is a well-kept secret of affordable quality of life. The city boasts a range of museums, some of the nation's largest summer festivals, a multi-cultural population rich in culinary and artistic tradition, a progressive downtown area, and many outdoor recreation opportunities, including plenty of parks, river walks, and public beaches. Housing is affordable, public and parochial schools are excellent, and traffic is a breeze. Milwaukee neighborhoods are known for variety, character, and unique architecture, offering superb quality of life and exceptional work-life balance in a city rife with history. With Chicago only 75 minutes away, world-class cultural and sporting venues and one of the world's busiest air travel hubs are within easy reach. #LI-EH1 #LI-Onsite #VBRI Not ready to apply? Connect with us for general consideration.

We are seeking a Special Investigative Unit (SIU) Coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Special Investigative Unit (SIU) Coordinator plays a critical role in overseeing and managing investigations related to fraud, abuse, and other compliance issues within the healthcare and social assistance sector. This position ensures that all investigative activities are conducted thoroughly, ethically, and in accordance with regulatory standards and organizational policies. The coordinator acts as a liaison between internal departments, external agencies, and legal entities to facilitate information sharing and resolution of cases. By leading a team of investigators, the coordinator ensures timely and accurate documentation, analysis, and reporting of findings to support corrective actions and risk mitigation. Ultimately, this role contributes to safeguarding organizational integrity, protecting members rights, and maintaining compliance with healthcare laws and regulations. Minimum Qualifications: Bachelor's degree in Criminal Justice, Healthcare Administration, Social Work, or a related field. Minimum of 3 years of experience in healthcare investigations, compliance, or a related area. Strong knowledge of healthcare laws, regulations, and compliance standards including HIPAA and Medicare/Medicaid rules. Proven experience in managing investigative teams or projects. Preferred Qualifications: Master's degree in Criminal Justice, Healthcare Administration, Social Work, or a related field. Certification in Fraud Examination (CFE) or Healthcare Compliance (CHC) is highly desirable. Experience working within a Special Investigative Unit or similar healthcare fraud prevention team. Familiarity with data analytics tools and investigative software. Advanced degree in a relevant field such as Public Health, Law, or Business Administration. Demonstrated ability to work collaboratively with law enforcement and regulatory agencies. Responsibilities: Manage and coordinate investigations of suspected fraud, waste, and abuse within healthcare programs, ensuring compliance with legal and regulatory requirements. Develop and implement investigative plans while maintaining confidentiality and security of sensitive information. Supervise, train, and support investigative staff, overseeing performance, case management, and professional development. Collaborate with internal departments and external agencies, including compliance, legal, clinical teams, law enforcement, and regulators. Prepare detailed reports, track investigative trends, and present findings to leadership, recommending policy or procedural changes to strengthen compliance and risk management.

Genie Healthcare is looking for a Administrative to work in Special Investigative Unit Investigator for a 11.71 weeks travel assignment located in Troy, Offsite Work Location for the Shift (5x8 Days - Please verify shift details with recruiter, 07:00:00-15:00:00, 8.00-5). Pay and benefits packages are estimated based on client bill rate at time the job was posted. These rates are subject to change. Exact pay and benefits vary based on several things, including, but not limited to, guaranteed hours, client changes in bill rate, experience, etc. Benefits: Medical Insurance, Dental Insurance, Vision Insurance, 401(k) with company matching (50% up to 6% of what you contribute)

Service Monitoring & Enforcement Department (SMED) Facility and Operations Field Division (FOFD) Hourly Rate: $33.52 About The Service Monitoring & Enforcement Department: The Service Monitoring and Enforcement Department's (SMED) mission is to enforce consumer safeguards, to resolve consumer complaints and to ensure Ohio utility consumers receive safe and reliable services. SMED is organized into three divisions. Facility Operations Field Division (FOFD) Facility Operations Field Division (FOFD) staff regularly inspects utility facilities and reviews plant operating practices to ensure regulated utility service providers deliver safe, reliable and quality service. Field investigators from the division's electric, telephone, water/wastewater and gas pipeline safety sections perform on-site inspections and audit company records to ensure utilities observe regulatory requirements. FOFD staff also participates in rate case proceedings and recommends changes in company policies and practices to improve utility service. FOFD staff also acts as the agency lead for the damage prevention complaint reporting and tracking process; assisting with the maintenance of the damage prevention enforcement database; and answering internal and public inquiries. What You'll Do: The Gas Pipeline Safety team at the PUCO is responsible for enforcing federal and state pipeline safety regulations. We work in partnership with the federal Pipeline and Hazardous Materials Safety Administration (PHMSA). In this position as a Gas Pipeline Safety Compliance Investigator, you will be a field-based employee responsible for scheduling, coordinating, and conducting independent field audits and inspections with gas utilities. Inspections include: * Reviews of company plans and procedures * Reviews of company construction, operations, and maintenance records * Field observations of gas company employees and contractors * Field inspections of company pipeline facilities. You will also be assigned to investigate natural gas related incidents and complaints. The position will involve learning and applying federal and state pipeline safety regulations to various company records and facilities to determine whether the company is complying with the regulations. Some inspections are performed as part of a team, but most inspections are performed independently. This position will be based in North Central Ohio and most assignments will be in that part of the state but occasional assignments requiring overnight stays in other parts of the state are possible. Travel to Columbus will also be required throughout the year for meetings at the PUCO headquarters in downtown Columbus. The position will also require the successful completion of several training courses at PHMSA's training facility in Oklahoma City, OK during the first 3 years in the position. A state vehicle will be assigned for work related travel within the state. The selected candidate must reside in or relocate to Marion, Morrow, Crawford, or Richland County areas. Please make sure the duty section of your work history clearly demonstrates 5 years of natural gas related experience to meet minimum qualifications. We will not be able to review any resumes or other attachments. Salary Information: Unless required by legislation or union contract, starting salary is set at the lowest rate of the salary range. In most cases, successful employees will increase a step in the salary range within six months, with subsequent step increases occurring every year. In addition, the State of Ohio offers cost of living adjustments, longevity supplements after five years of public service, and wellness incentives. 5 yrs. exp. in construction & operation of natural gas pipeline systems; 1 course or 3 mos. trg. in general management; 3 mos. trg. or 3 mos. exp. in public relations; valid driver's license. * Or 5 yrs. exp. as gas pipeline safety inspector & successful completion of seven basic gas pipeline safety courses from Transportation Safety Institute; valid driver's license. * Or completion of undergraduate core program in mechanical, electrical or civil engineering; valid driver's license. * Or completion of undergraduate core program in mechanical, electrical or civil engineering technology; 3 yrs. exp. in construction & operation of natural gas pipeline systems; successful completion of seven basic Transportation Safety Institute courses in gas pipeline safety; valid driver's license. * Or completion of undergraduate core program in mechanical, electrical or civil engineering technology; 3 yrs. exp. as gas pipeline safety inspector; completion of seven basic gas pipeline safety courses from Transportation Safety Institute; valid driver's license. * Or equivalent of Minimum Class Qualifications for Employment noted above. Job Skills: Utilities