Lead Managed Care Investigator

dpi.nc.gov

North Carolina, US
$66,696 - $110,049; recruitment range: $66,696 - $...
Hybrid
Managed care organizations oversight
Medicaid program compliance
Investigative techniques
The Lead Managed Care Investigator plays a critical role in ensuring quality and compliance within the Medicaid program by providing oversight of vendors and Managed Care Organizations

Job Summary

  • The Lead Managed Care Investigator plays a critical role in ensuring quality and compliance within the Medicaid program by providing oversight of vendors and Managed Care Organizations.
  • This position involves collaboration with local non-governmental entities, the Attorney General’s Office, and other oversight partners, as well as coordination with service providers.
  • The role serves as a subject matter expert in consultations with management and team members regarding Medicaid policies and procedures.

Matching Summary

The Lead Managed Care Investigator plays a critical role in ensuring quality and compliance within the Medicaid program by providing oversight of vendors and Managed Care Organizations.

Salary

$66,696 - $110,049; Recruitment Range: $66,696 - $85,717; Benefits: Not specified

Skills & Requirements

Must-have

  • Managed Care Organizations oversight
  • Medicaid program compliance
  • Investigative techniques
  • Audit activities
  • Technical support for staff

Nice-to-have

  • Consulting on clinical policy
  • Fraud, Waste, and Abuse investigations
  • Collaboration with diverse stakeholders
  • Data analysis and program evaluation

Key Requirements

  • Licensed Registered Nurse in North Carolina
  • Two years of clinical experience
  • Ability to interpret regulations and policies
  • Proficiency in Microsoft Office applications

Work Rights

Not specified

Tailored Resume

Cover Letter