Managed Care Oversight Investigator I

dac.nc.gov

North Carolina, US
$52,592 - $92,036; $50,633 - $63,500; not specifie...
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 by reviewing referral documentation, analyzing data, and collaborating with stakeholders.
  • 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

$52,592 - $92,036; $50,633 - $63,500; Not specified

Skills & Requirements

Must-have

  • Medicaid program integrity
  • investigate provider billing
  • analyze member and provider data
  • compliance with managed care regulations

Nice-to-have

  • clinical policy interpretation
  • working with managed care organizations
  • fraud, waste, and abuse credibility

Key Requirements

  • Master's degree and two years of related experience OR Bachelor's degree and four years of related experience OR equivalent combination
  • Experience interpreting and consulting on clinical policy
  • Experience working with managed care organizations
  • Experience performing investigations to establish Fraud, Waste, and Abuse credibility

Work Rights

Not specified

Tailored Resume

Cover Letter