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)
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:
Required Qualifications:
This position reports to Capital Rxs Chief Compliance Officer.
Base Salary: $100,000 - $150,000
Nothing in this position description restricts managements 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 nations 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 companys 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.