Lead Managed Care Investigator

Department of Health and Human Services

North Carolina, US
Base: $66,696 - $110,049; recruitment range: $66,6...
Hybrid
Medicaid program compliance
Managed care organization oversight
Investigative techniques
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
  • Managed Care Organization oversight
  • Investigative techniques
  • Data analysis and quality assurance
  • Collaboration with stakeholders

Nice-to-have

  • Consulting on clinical policy
  • Experience with investigative audits
  • Fraud, Waste, and Abuse investigations
  • Strong organizational skills
  • Proficiency in Microsoft Office

Key Requirements

  • Licensed Registered Nurse in North Carolina
  • Two years of clinical experience
  • Ability to interpret state and federal regulations

Work Rights

Not specified

Tailored Resume

Cover Letter