Manager, Special Investigations Unit

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

• 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, over payments, 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

• 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.

• Performs all other miscellaneous responsibilities and duties as assigned or directed.