Fraud, Waste, And Abuse Investigations Manager

MedImpact Healthcare Systems, Inc.

San Diego, California, United States
Base: $85,356 - $115,232 - $145,107; bonus/equity:...
Fully remote
7+ years experience in fraud investigation
Clinical review of medical records
Knowledge of medicaid and medicare part d
The role involves conducting comprehensive clinical investigations into potential external fraud and abuse involving commercial and government lines of business

Job Summary

  • The role involves conducting comprehensive clinical investigations into potential external fraud and abuse involving commercial and government lines of business.
  • Candidates must utilize prescription and medical claim data to generate clinical recommendations according to Global Drug Utilization Review program protocols.
  • The position offers a competitive salary range of $85,356 to $145,107 along with comprehensive benefits including medical, dental, vision, and 401K matching.

Matching Summary

The role involves conducting comprehensive clinical investigations into potential external fraud and abuse involving commercial and government lines of business.

Salary

Base: $85,356 - $115,232 - $145,107; Bonus/Equity: Incentive Compensation mentioned; Benefits: Medical/Dental/Vision, PTO, 401K match, Tuition Reimbursement

Skills & Requirements

Must-have

  • 7+ years experience in fraud investigation
  • Clinical review of medical records
  • Knowledge of Medicaid and Medicare Part D
  • SQL and relational database proficiency
  • MedOptimize software familiarity
  • State and federal healthcare fraud laws

Nice-to-have

  • Strong interpersonal communication skills
  • Experience mentoring investigative staff
  • Ability to work under adverse conditions
  • Process improvement initiative skills
  • Court testimony experience preferred

Key Requirements

  • BS/BA degree required
  • 7+ years of relevant experience
  • 4 years SME in respective areas
  • US work authorization required (no sponsorship)
  • Proficiency in MS Office and SQL

Work Rights

Must have US work authorization

Tailored Resume

Cover Letter