Lead Managed Care Investigator

North Carolina Department of Health and Human Services (DHHS)

North Carolina, US
Grade mh17: $66,696 - $110,049; recruitment range:...
Hybrid
Managed care organization oversight
Medicaid program compliance
Investigative support and audit activities
The Lead Managed Care Investigator plays a critical role in ensuring quality and compliance within the Medicaid program

Job Summary

  • The Lead Managed Care Investigator plays a critical role in ensuring quality and compliance within the Medicaid program.
  • This position is responsible for providing oversight of vendors and Managed Care Organizations (MCOs), supporting investigations, and engaging in audit activities.
  • This position is eligible for a hybrid-teleworking schedule to include weekly onsite work hours.

Matching Summary

The Lead Managed Care Investigator plays a critical role in ensuring quality and compliance within the Medicaid program.

Salary

Grade MH17: $66,696 - $110,049; Recruitment Range: $66,696 - $85,717

Skills & Requirements

Must-have

  • Managed Care Organization oversight
  • Medicaid program compliance
  • Investigative support and audit activities
  • Collaboration with oversight partners
  • Technical support and quality assurance

Nice-to-have

  • Subject matter expert in Medicaid policy
  • Consultation with management and team
  • Experience with Fraud, Waste, and Abuse

Key Requirements

  • Licensed Registered Nurse in North Carolina
  • Two years of clinical experience
  • Equivalent combination of education and experience

Work Rights

Not specified

Tailored Resume

Cover Letter