Associate Director, Provider Compliance

NC Department of Health and Human Services (DHHS)

North Carolina, USA
Base: $100,641 - $107,816; bonus/equity: not speci...
Hybrid
Provider audits and investigations
Managed care plan oversight
Fraud, waste, and abuse prevention
The Associate Director, Provider Compliance is responsible for establishing and executing effective oversight protocols of Special Investigations Units and developing procedures for provider audits and investigations to reduce fraud, waste, and abuse

Job Summary

  • The Associate Director, Provider Compliance is responsible for establishing and executing effective oversight protocols of Special Investigations Units and developing procedures for provider audits and investigations to reduce fraud, waste, and abuse.
  • This senior management position will ensure NC Medicaid managed care organizations adhere to sound principles for audits, investigations, and monitoring, working in partnership with Provider Operations and Clinical Policy.
  • The role involves leading policy development, overseeing vendor work, enforcing provider policies, and collaborating with analytics, investigations, and legal counsel for compliance initiatives.

Matching Summary

The Associate Director, Provider Compliance is responsible for establishing and executing effective oversight protocols of Special Investigations Units and developing procedures for provider audits and investigations to reduce fraud, waste, and abuse.

Salary

Base: $100,641 - $107,816; Bonus/Equity: Not specified; Benefits: Comprehensive state benefits package

Skills & Requirements

Must-have

  • Provider audits and investigations
  • Managed care plan oversight
  • Fraud, waste, and abuse prevention
  • Policy and procedure development
  • Cross-functional collaboration

Nice-to-have

  • Data-driven investigative strategies
  • Personnel management
  • Vendor relationship management
  • Healthcare operations knowledge

Key Requirements

  • Master's degree and 5 years experience (3 supervisory)
  • Bachelor's degree and 7 years experience (3 supervisory)
  • Equivalent combination of education and experience
  • Experience in Medicaid or managed care
  • Experience managing personnel in audits/investigations

Work Rights

Not specified

Tailored Resume

Cover Letter