Job Description

1. Program Oversight/Leadership for FWA SIU:
   
   • Provide strategic oversight of the FWA SIU program
   • Ensure compliance with all applicable FWA regulatory requirements
   • Maintain independence and objectivity of SIU investigations
   • Oversee intake, prioritization, and outcomes of investigations
   • Review and approve investigative findings and referrals
   • Escalate significant FWA risks to executive leadership
   • Oversee vendor and delegated FWA/SIU activities
   • Monitor FWA trends, metrics, and program effectiveness
   • Oversee FWA related reporting
   • Support audit readiness and regulatory inquiries
2. Cross-Functional Team Partnerships:
   
   • Partner with Compliance to ensure regulatory alignment and audit readiness
   • Collaborate with Medical Management on utilization and clinical FWA risks
   • Coordinate with Provider Relations on provider actions and remediation
   • Work with Finance on recoveries, overpayments, and financial reporting
   • Coordinate with Legal as appropriate on investigations, and enforcement actions
   • Support Operations with FWA education, guidance, and risk mitigation
   • Coordinate with delegated entities and vendors on FWA oversight and reporting
   • Serve as the primary SIU liaison to internal and external stakeholders
3. Leadership:
   
   • Selects, trains, develops and organizes staff.
   • Monitors overall inventory of work and prioritizes the staff's work to meet performance standards and authorizes additional resources as needed.
   • Provides feedback and coaching (helping individuals to solve problems/issues on their own) including timely completion of any interim and year-end performance reviews.
4. Performs all other miscellaneous responsibilities and duties as assigned or directed.

1. Bachelor's degree and five years of related work experience; or equivalent combination of education and work experience.
2. Three years of supervisory or management experience.
3. Effective verbal and written communication skills.
4. Collaborative crisis management skills.
5. Ability to develop programs based on relevant industry best practice and regulations.
6. Interpretation of government regulations and applicable codes to ensure compliance.
7. Basic working knowledge of Microsoft Office application, including word, excel, powerpoint, outlook.