High-Risk Provider Management Supervisor; WMS​/DAIO

This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.

All HCA employees are required to be Washington state residents upon their first day of employment.

Protect Washington's Medicaid program and the people it serves. The Division of Audit, Integrity, and Oversight (DAIO) is seeking a High-Risk Provider Management Supervisor to lead HCA's new High-Risk Provider Management Team. This team is HCA's primary authority for overseeing high- and moderate-risk Medicaid providers, administering enhanced oversight mechanisms, and developing provider termination and disenrollment recommendations. You will set the policies and procedures that guide consistent risk determinations and enforcement actions, and coordinate with managed care organizations, sister agencies, and law enforcement to bring accountability and transparency to how Medicaid funds are spent.

• Supervise a team of professional staff responsible for enhanced oversight, monitoring, and site visits of high- and moderate-risk Medicaid providers.
• Assign and elevate provider risk levels, initiate required fingerprint-based criminal background checks, and enforce regulatory deadlines.
• Authorize and plan unannounced site visits, develop field task orders and standard operating procedures, and manage the site visit team's budget of approximately $200,000 a year.
• Oversee daily screening of providers against the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM), along with reviews of billing patterns, geographic data, and corporate histories.
• Identify red flags, elevate concerns to leadership or HCA's Special Investigations Unit, and coordinate with CMS, law enforcement, the Medicaid Fraud and Abuse Division, and other oversight entities.
• Develop legally defensible denial and termination letters, evidence packets, and recommendations that support risk decisions during provider appeal hearings.
• Partner with Provider Enrollment on revalidation schedules and on provider termination and enrollment policy recommendations.
• Develop policies and procedures for temporary provider moratoria under 42 CFR 455.470.
• Analyze legislation affecting program integrity, advise executive leadership, and contribute to WAC development and agency-wide process improvements.

• You’ll be on the front line of protecting Medicaid clients and public dollars, influencing the integrity of billions of dollars in services.
• You’ll help build a new team from the ground up, setting the practices and standards it will rely on for years to come.
• You’ll work alongside federal partners, law enforcement, and sister agencies on complex cases where your judgment makes a real difference.
• You’ll lead a dedicated team while working remotely, with alternative work schedules available based on business needs.

You are a steady, detail-oriented leader who meets your commitments, works independently, and stays focused under pressure, making sound decisions even when there is no precedent to follow. You deal with others in a straightforward and honest way, maintain confidentiality, and support agency values. You bring strong interpersonal skills, respond to questions and concerns with professionalism and care, and hold yourself and your team to a high standard of accuracy and continuous quality improvement.

You coach your staff in ways that build a strong culture of compliance.

Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter,…