Job description
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering a whole bunch of smart, big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, and technology. We want to throw the long ball with people we love for a cause we believe in. Life is short. Join us.
Job Description
A bit more about this role:
As the Sr. Manager of the Special Investigation Unilt (SIU) for Devoted Health, you will be reporting directly to our Chief Compliance Officer. In this position, you will be responsible for the oversight of the Special Investigations Unit (SIU) and support the Chief Compliance Officer in the oversight of our Fraud, Waste & Abuse (FWA) Program.. The Sr. Manager oversees case referrals and investigations, manages our FWA vendor, responsible to report investigations to regulatory agencies, respond to government requests for information related to FWA, develops and maintains employee education and identifies new recovery opportunities, goals, and sound practices.
Responsibilities will include:
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Lead the triage and case management process that maximizes recoveries and referrals for Devoted Health while concurrently documenting all cases with criteria that enables high quality internal and external regulatory audit
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Vendor oversight and management of our Program Integrity vendor partners - specifically managing the relationship, quality of their work and contractual requirements
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Co-chair the Fraud, Waste and Abuse Committee in effectively reporting and communicating trends, savings, vendor performance, etc
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Day-to-Day leadership and management of the staff and caseloads is critical, therefore a disciplined approach to triage from referrals and validation in conjunction with internal and vendor data mining queries is essential
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Work closely with each market president, pharmacy operations, compliance, and other key operational and clinical staff to communicate potential fraud and abuse that may be taking place within the respective plans and operational areas.
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Develop and execute an SIU plan in collaboration with business partners
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Work closely with state and federal program integrity organizations, and the Medicaid Fraud Control Unit (MFCU), MEDIC, or other agencies in representing Devoted Health
Attributes to success:
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Maintains quality service by establishing and enforcing organization standards.
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The ability to work independently and get the job done!
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Curious and inquisitive
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Detailed oriented
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Meeting deadlines
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Passionate about Medicare and the members we serve
Desired skills and experience:
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Knowledgeable of applicable fraud statutes and regulations
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Ability to work independently with excellent time management skills while still contributing to the needs of the Team
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Strong critical thinking, analytical skills, and investigative curiosity
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High degree of integrity as demonstrated by appropriate treatment of confidential information, adherence to policies, rules and regulations, and professional conduct in dealing with constituents
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Knowledge of medical claims processing and investigations
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Knowledge of Medicare and Medicaid products
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Ability to work in a startup, fast paced environment
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Strong written and communication skills
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Medicare SIU experience preferred
Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.
If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking for a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you!
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Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.
COVID-19 Vaccination Requirement: Where permitted by applicable law, candidates must have received or be willing to receive the COVID-19 vaccine by date of hire to be considered. The Company will provide reasonable accommodations to qualified employees with disabilities or for a sincerely held religious belief, practice, or observance.
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