Healthcare Compliance Investigator, Yale Health

Overview

In 1971, Yale University established Yale Health to provide health services to its facility, staff and students through a multidisciplinary health maintenance organization located on campus. Yale Health has more than 50,000 members including students, staff, faculty and their families who come from every state in the country and almost every country in the world. With over 50 years of service to the Yale community, our state‑of‑the‑art facility at 55 Lock Street is where our members receive most of their care from our 150+ providers.

It is a 144,000 square foot medical facility with over 90 exam rooms, an Acute Care Department, a 15‑bed inpatient facility with two negative pressure rooms, a diagnostic imaging suite including MR and CT scan, x‑ray and ultrasound and a full‑service retail pharmacy.

• Consult with management, Office of General Counsel, Human Resources and/or the Sr. Director of Compliance & Privacy Officer as needed to resolve difficult, highly sensitive or complex compliance issues.
• Independently evaluate and assess allegations to determine whether laws, policies or regulations have been violated.
• Plan and conduct complex, confidential internal investigations from inception to conclusion, including defining investigation strategy, preserving evidence, conducting interviews, analyzing records, conducting root‑cause analysis, and recommended corrective actions.
• Conduct, manage, and document interviews with internal witnesses, as required for investigatory purposes.
• Identify risks, interpret investigation results, and recommend and communicate corrective actions to mitigate future potential risks.
• Perform follow‑up to ensure remedial/disciplinary measures are implemented appropriately and timely.
• Plan, develop, lead, and manage multiple projects, including prioritizing and managing through execution.
• Maintain meticulous case files and chronologies in accordance with best practices and record retention laws.
• Thoroughly document, organize, and review case files, relative to each investigation in accordance with University policy. Prepare clear and concise draft investigation plans and reports.
• Attend, actively participate in, and/or lead meetings with various business area managers.
• Communicate directly with Federal or State regulators.
• Support the development and maintenance of Compliance & Privacy policies, procedures and workflows.
• Participate in and lead special projects (e.g., auditing, training, HIPAA & FERPA compliance).
• Provide support and guidance to other team members.
• Comply with all University policies and standards.
• Perform other duties as assigned.

Full‑time, 37.5 hrs. Generally scheduled M‑F, 8:30 am – 5:00 pm. Evenings, weekends, holidays and recess periods may also be required.

• Ability to maintain strict confidentiality of sensitive information with professionalism and discretion.
• Excels at multitasking, balancing accuracy and attention to detail in fast‑paced, interruption‑heavy environments. Exercises sound judgment, prioritizes effectively, and anticipates needs to meet deadlines with initiative and problem‑solving.
• Demonstrates strong interpersonal skills and a customer service mindset, working effectively with diverse stakeholders.
• Delivers clear, professional communication—oral and written—with strong organizational and analytical abilities.
• Proficient in Microsoft Office Suite (Word, PowerPoint, Excel, databases), with strong internet research skills.
• Proficient in using the electronic health record (EHR) systems, preferably EPIC.
• Excellent attendance, punctuality and reliability.

• Master’s Degree;
  Bachelor’s degree in criminal justice, healthcare or public administration, English or related field of study.
• Previous experience as an investigator in a healthcare environment.
• 6+ years progressive experience in conducting and managing complex investigations or auditing and risk analysis.
• 6+ years’ experience reading, analyzing and interpreting State and Federal laws, rules and regulations.
• Certified in Healthcare Compliance (CHC);
  Certified in Healthcare Privacy Compliance (CHPC);
  Certified Compliance…