Managed Care Oversight Investigator I

historicsites.nc.gov

Unknown, North Carolina, US
Recruitment range: $50,633 - $63,500; salary grade...
Hybrid
Medicaid program integrity
Investigate provider billing
Analyze member and provider data
The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network

Job Summary

  • The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network.
  • This role supports the integrity of state healthcare expenditures and promotes program compliance.
  • The State of North Carolina offers excellent comprehensive benefits, including health insurance, retirement plans, and paid leave.

Matching Summary

The Managed Care Oversight Investigator conducts inquiries and investigations into suspected fraud, waste, and abuse within the Medicaid behavioral and physical health provider network.

Salary

Recruitment Range: $50,633 - $63,500; Salary Grade Range: $52,592 - $92,036; Benefits: Comprehensive state benefits

Skills & Requirements

Must-have

  • Medicaid program integrity
  • investigate provider billing
  • analyze member and provider data
  • compliance with regulations
  • fraud, waste, and abuse investigations

Nice-to-have

  • collaboration with stakeholders
  • program integrity functions
  • clinical policy interpretation
  • hybrid-teleworking schedule

Key Requirements

  • Master's degree and two years related experience
  • Bachelor's degree and four years related experience
  • Equivalent combination of education and experience
  • Must be authorized to work in the US

Work Rights

Not specified

Tailored Resume

Cover Letter