Lead Managed Care Investigator

North Carolina Department of Health and Human Services (DHHS)

Wake County, NC, United States
Base: $66,696 - $110,049; recruitment range: $66,6...
Hybrid
Medicaid program compliance
Vendor and mco oversight
Investigative 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

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

Skills & Requirements

Must-have

  • Medicaid program compliance
  • Vendor and MCO oversight
  • Investigative activities
  • Audit activities
  • Collaboration with AG's Office
  • Technical support for staff

Nice-to-have

  • Consulting on clinical policy
  • Investigative audits
  • Fraud, Waste, and Abuse credibility

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter