Manager, Special Investigation Unit - Hybrid, Indiana Residency Required

We are looking for a Manager, Special Investigative Unit to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Summary:

This position manages and directs the activities of the Special Investigative Unit and is a subject matter expert in Medicaid program integrity. This position works with both the legal and compliance departments. The Special Investigative Unit Manager reports directly to the General Counsel.

This is a leadership position with requirement to report on site in Indianapolis, IN as identified by the leader.

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Required:

• Bachelor's degree in health care, management, math, health information systems or related field or Associate's degree with two (2) years of related experience; or High School diploma with four (4) years of related experience.
• Three (3) years' experience in fraud, waste, and abuse audits and/or investigations; internal audits and/or investigations; and/or criminal audits and/or investigations, with direct, related complex progressive experience, including two (2) years' experience in a management role with direct reports leading or assisting in all phases of effective supervision (i.e.. Recruitment, performance management, training).
• Candidate must be approved by the Indiana Medicaid agency prior to hiring and the agency may ask to interview candidate.

Preferred:

• 2 years' experience and knowledge of HMO, PPO, TPA, PHO and managed care functions (e.g. marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements.
• Certification as a Certified Fraud Examiner (CFE), Certified Professional Medical Auditor or Accredited Healthcare Fraud Investigator