Lead Managed Care Investigator
Share
Job Location:
Wake County, NC - USA
Monthly Salary:
$ 66696 - 110049
Posted on:
17 hours ago
Vacancies:
1 Vacancy
Job Summary
Agency
Dept of Health and Human ServicesDivision
HEALTH BENEFITSJob Classification Title
Nurse Consultant II (NS)Position Number
Grade
MH17About Us
The North Carolina Department of Health and Human Services (DHHS) is one of the largest most complex agencies in the state and has approximately 17000 employees. It is responsible for ensuring the health safety and well-being of all North Carolinians providing human service needs for special populations including individuals who are deaf blind developmentally disabled and mentally ill and helping poor North Carolinians achieve economic independence.
Description of Work
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 role involves collaboration with local non-governmental entities the Attorney Generals Office (AGO) and other oversight partners as well as coordination with service providers. Additional responsibilities include staff technical support quality assurance of work and providing support for various operational needs. This position also serves as a subject matter expert (SME) in consultations with management and team members regarding Medicaid policies and procedures involving OCPI functions and other administrative matters.Knowledge Skills and Abilities/Management Preferences
Salary Grade Range $66696 - $110049
Recruitment Range $66696 - $85717
**Position is eligible for a hybrid-teleworking schedule to include weekly onsite work hours**
Candidates now meet the minimum qualifications of a position if they meet the minimum education and experience listed on the vacancy announcement.
The Knowledge Skills and Abilities (KSAs)/ Management Preferences are not required. Applicants who possess the following skills are preferred:
Working knowledge of Medicaid program objectives clinical billing medical coding documentation standards and state/federal regulatory requirements including certifying and accrediting body standards.
Ability to interpret and apply state and federal regulations managed care contracts provider standards and program policies to ensure compliance across statewide program components.
Skilled in data collection analysis program evaluation quality assurance investigative techniques and conducting audits and documentation reviews.
Strong communication skills both oral and written with experience explaining policy delivering training and collaborating effectively with agencies providers and diverse stakeholder groups.
Highly organized with the ability to plan prioritize and manage daily assignments supported by proficiency in Microsoft Office applications to produce highquality deliverables.
Management Preference
Experience interpreting and consulting on clinical policy.
Experience working with managed care organizations that includes investigative audits and reporting asks.
Experience performing investigations to establish Fraud Waste and Abuse credibility.
Physical Requirements: Standing Walking Fingering Talking Hearing Repetitive movements.
Minimum Education and Experience
Some state job postings say you can qualify by an equivalent combination of education and experience. If that language appears below then you may qualify through EITHER years of education OR years of directly related experience OR a combination of both. See the Education and Experience Equivalency Guide for details.
Some state job postings say you can qualify by an equivalent combination of education and experience. If that language appears below then you may qualify through EITHER years of education OR years of directly related experience OR a combination of both. See the Education and Experience Equivalency Guide for details.
Licensed to practice as a Registered Nurse in the State of North Carolina and two years of clinical experience in the area of specialization.
EEO Statement
The State of North Carolina is an Equal Employment Opportunity Employer and dedicated to providing employees with a work environment free from all forms of unlawful employment discrimination harassment or retaliation. The state provides reasonable accommodation to employees and applicants with disabilities; known limitations related to pregnancy childbirth or related medical conditions; and for religious beliefs observances and practices.
Recruiter:
Lisa M SasserEmail:
