Special Investigations Unit Director jobs in New York

Special Investigations Unit Director oversees the operations for conducting thorough investigations. Develops the strategies for the cross-functional detection and elimination of fraudulent behavior. Being a Special Investigations Unit Director prepares investigative reports and analyses that pertinent to evidence obtained during investigations. May coordinate with outside sources such as law enforcement agencies, and external audit, etc. Requires a bachelor's degree. Additionally, Special Investigations Unit Director typically reports to top management. The Special Investigations Unit Director manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Special Investigations Unit Director typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Special Investigations Unit (SIU) Manager
  • Capital Rx
  • New York, NY FULL_TIME
  • Seeking candidate to lead Capital Rx's Fraud, Waste, and Abuse (FWA) program, ensuring compliance. The candidate will Develop internal SIU/FWA policies, conduct audits, and implement prevention strategies. Utilize investigative techniques and data analytics to identify FWA trends. Strong analytical skills and FWA regulation knowledge are required for this remote role.

    Position Responsibilities:

    • Develop and manage an effective fraud, waste, or abuse (FWA) program in accordance with applicable laws, regulations, accreditation requirements, and other guidance.
    • Develop and implement internal SIU/FWA policies and procedures, including processes for routine FWA audits and other prevention, detection, and correction activities.
    • Utilize various investigative techniques and tools to gather evidence and proactively identify potential FWA activity, including identifying trends and patterns of FWA activity through data mining and analytics.
    • Investigate incidents related to pharmacy, member, and/or prescriber potential FWA.
    • Analyze complex information and draw conclusions that support investigative findings.
    • Prepare detailed reports and presentations on investigation efforts, findings, and remediation recommendations.
    • Monitor and track outcomes of investigations to ensure appropriate actions are taken and potential risks are mitigated.
    • Maintain strict confidentiality and adhere to ethical standards in all aspects of investigations.
    • Develop FWA training and education for workforce members, Board members, and enrollees to enhance knowledge and skills related to FWA detection, reporting, and investigation.
    • Collaborate with departments to implement a cross-functional FWA workgroup focused on FWA prevention and detection strategies and initiatives.
    • Prioritize and manage workload effectively to ensure timely and accurate completion of investigations and other tasks.
    • Serve as a subject matter expert on fraud-related matters and provide guidance and support to the organization.
    • Stay up to date on industry regulations and best practices related to fraud detection and prevention.
    • Develop and maintain collaborative relationships with internal departments, clients’ FWA/SIU professionals, law enforcement, and regulatory agencies.
    • Testify in court or other legal proceedings as needed.
    • Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

    Required Qualifications:

    • National Health Care Anti-Fraud Association certification (AHFI), Certified Fraud Examiner (CFE), or America’s Health Insurance Plans Health Care Anti-Fraud Associate (HCAFA) designation.
    • Bachelor’s degree in healthcare, Criminal Justice, Law Enforcement, or another related field. Extensive work experience may be considered in lieu of degree(s).
    • 5 years of experience in fraud investigation, a special investigation unit, Medicare or Medicaid fraud detection unit, or a related field, including two (2) years of active experience in auditing and investigating in the healthcare industry.
    • Knowledge of federal and state laws related to healthcare FWA. This includes a solid understanding of applicable statutes such as the False Claims Act, anti-kickback statute, and Stark law.
    • Strong analytical and critical thinking skills.
    • Excellent communication and interpersonal skills.
    • Attention to detail & commitment to delivering high-quality work products.
    • Ability to balance multiple complex projects simultaneously.

    This position reports to Capital Rx’s Chief Compliance Officer.

    Base Salary: $100,000 - $150,000

    Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

    About Capital Rx

    Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

    Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

  • 13 Days Ago

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Special Investigations Unit (SIU) - Field Investigator
  • Ethos Risk Services
  • Brooklyn, NY PART_TIME
  • Ethos is looking to hire a part time, experienced Insurance related SIU / Claims Field Investigator in the Brooklyn, NY area. JOB DESCRIPTION: The Special Investigations Unit (SIU) Field Investigator ...
  • 15 Days Ago

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Office Clerk
  • Buffalo Special Investigations (BSI Security)
  • Buffalo, NY FULL_TIME,PART_TIME
  • Office Clerk: We are looking for a competent Office Clerk to perform various administrative and clerical tasks to support our business. The office clerk will perform numerous tasks, such as answering ...
  • Just Posted

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Director Trials and Investigations
  • Metropolitan Transportation Authority
  • Jamaica, NY FULL_TIME
  • Description Position at Long Island Rail Road Job InformationTitle: Director-Trials and InvestigationsDepartment: Labor RelationsPosting Date: 07/03/2023Close Date: Open until filled.Hay Point Evaluat...
  • 18 Days Ago

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Director of Investigations and Trials
  • City of New York
  • Central, NY FULL_TIME
  • Job Description The NYC Department of Probation (DOP) is a world leader in working creatively and effectively engaging with people under court-mandated community supervision. Through innovative partne...
  • 18 Days Ago

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Director of Investigations and Trials
  • NYPD Civilian Jobs
  • Manhattan, NY FULL_TIME
  • DEPARTMENT OF PROBATION Full-Time Location MANHATTAN No Exam Required Department MVEP/Gen'l Counsel Salary Range: $70,940.00 – $189,574.00 Job Description The NYC Department of Probation (DOP) is a wo...
  • 19 Days Ago

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National Account Manager
  • Lincoln Search Consultants
  • Columbus, OH
  • This privately held financially stable client is seeking a Business Development Manager to be the main point of contact ...
  • 3/28/2024 12:00:00 AM

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National Account Manager
  • Management Business Solutions
  • Columbus, OH
  • This privately held financially stable client is seeking a Business Development Manager to be the main point of contact ...
  • 3/28/2024 12:00:00 AM

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Director, Background Investigations
  • Fidelity Investments
  • Roanoke, TX
  • Job Description: The Role Fidelity's reputation is built on trust. The mission of Fidelity Background Investigations is ...
  • 3/28/2024 12:00:00 AM

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Part-Time Firefighter
  • City of Oberlin, OH
  • Oberlin, OH
  • Salary: $15.00 Hourly Location : Oberlin, OH Job Type: Part-Time Job Number: 202100061 Department: Fire Opening Date: 07...
  • 3/28/2024 12:00:00 AM

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Human Resources Officer
  • City of Bangor, ME
  • Bangor, ME
  • Get Email Updates Subscribe to Receive Email Notifications from the City of Bangor City Directory View a list of City Co...
  • 3/28/2024 12:00:00 AM

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Marketing/Digital Communications Coordinator
  • Marianist Province of the United States
  • St Louis, MO
  • THE MARIANIST PROVINCE OF THE UNITED STATES POSITION DESCRIPTION TITLE: Marketing/Digital Communications Coordinator FLS...
  • 3/27/2024 12:00:00 AM

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Senior Clinical Research Coordinator
  • Brigham and Women's Hospital
  • Boston, MA
  • The Men's Health: Aging and Metabolism Clinical Research Unit at Brigham and Women's Hospital conducts government and in...
  • 3/26/2024 12:00:00 AM

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Claims Coordinator
  • Plastic Express
  • Baytown, TX
  • Company Overview Come join a winning Team! Since 1970 Plastic Express has met the bulk trucking, bulk terminal, packagin...
  • 3/26/2024 12:00:00 AM

New York is a state in the Northeastern United States. New York was one of the original thirteen colonies that formed the United States. New York covers 54,555 square miles (141,300 km2) and ranks as the 27th largest state by size.[3] The highest elevation in New York is Mount Marcy in the Adirondacks, at 5,344 feet (1,629 meters) above sea level; while the state's lowest point is at sea level, on the Atlantic Ocean. In contrast with New York City's urban landscape, the vast majority of the state's geographic area is dominated by meadows, forests, rivers, farms, mountains, and lakes. Most of...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Special Investigations Unit Director jobs
$165,543 to $249,356

Special Investigations Unit Director in Waco, TX
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