Associate Director, Provider Compliance

North Carolina Department of Health and Human Services (DHHS)

North Carolina, USA
Base: $100,641 - $107,816; bonus/equity: not speci...
Hybrid
Provider fraud, waste, and abuse detection
Oversight of managed care plans
Provider audit and investigation procedures
The Associate Director, Provider Compliance is responsible for establishing and executing effective oversight protocols of the Special Investigations Units of the State’s contracted health plans while developing and implementing procedures for conducting provider audits and investigations

Job Summary

  • The Associate Director, Provider Compliance is responsible for establishing and executing effective oversight protocols of the Special Investigations Units of the State’s contracted health plans while developing and implementing procedures for conducting provider audits and investigations.
  • This position will ensure NC Medicaid managed care organizations have and follow sound principles and practices for conducting provider audits, investigations and monitoring.
  • The State of North Carolina offers excellent comprehensive benefits, including health insurance options, retirement plans, NCFlex program, paid vacation, sick, and community service leave, and paid parental leave.

Matching Summary

The Associate Director, Provider Compliance is responsible for establishing and executing effective oversight protocols of the Special Investigations Units of the State’s contracted health plans while developing and implementing procedures for conducting provider audits and investigations.

Salary

Base: $100,641 - $107,816; Bonus/Equity: Not specified; Benefits: Comprehensive state benefits package

Skills & Requirements

Must-have

  • Provider fraud, waste, and abuse detection
  • Oversight of managed care plans
  • Provider audit and investigation procedures
  • Medicaid and CMS regulations
  • Cross-functional collaboration

Nice-to-have

  • Data-driven investigative strategies
  • Personnel management and development
  • Vendor relationship management
  • Public sector healthcare experience

Key Requirements

  • Master's degree and 5 years of experience (3 supervisory)
  • Bachelor's degree and 7 years of experience (3 supervisory)
  • Equivalent combination of education and experience
  • Hybrid-teleworking schedule eligibility

Work Rights

Not specified

Tailored Resume

Cover Letter