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Director of Special Investigations - Remote - Kingston, NY area


Director of Nursing


Kingston, New York, United States

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

The Director of Special Investigations: will be responsible for investigating allegations of Healthcare Fraud, Waste and Abuse impacting the Empire Plan benefit program of New York State in non - compliance per New York State, Medicare Part D or SOX requirements. The Director of Special Investigations will assess reported allegations, identify applicable governing laws, regulations, and policies, and conduct investigations, including analyzing documents and interviewing witnesses by developing functional, market level, and/or site strategy, plans, production and/or organizational priorities. The person in this role also identifies and resolves technical, operational and organizational problems outside own team.

If you are located in reside in Latham/Kingston, NY area, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges.

Primary Responsibilities:
The Director of Special Investigations will:

  • Analyze facts uncovered through the investigation against controlling statutes, laws, regulations, policies and guidance, and make a merit determination for all allegations
  • Produce high quality written summaries for the investigation and witness interviews, and for business leadership briefings
  • Collaborate with legal, compliance, Human Capital, and business partners throughout the investigation, and will also work with UHG Enterprise Compliance leadership
  • Help business compliance partners identify and recommend process improvements and best practices to promote compliance
  • Perform audit, assist with audit and communicate audit findings; review recommendations to ensure accuracy and consistency with procedure and internal processes
  • Build consensus, negotiate and influence others regarding matters of compliance

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Associate’s degree, Bachelor’s degree preferred, in Criminal Justice or equivalent undergraduate level degree
  • 5+ years of experience in oversight of a health care fraud, waste and abuse investigation unit
  • 3+ years of People management experience (i.e. have multiple direct reports)
  • Experience with investigating and assessing complex problems and recommend the appropriate compliance solutions
  • Experience managing multiple projects / tasks (role will have a typical caseload of 50-100 cases)
  • Intermediate or better level of proficiency using MS Word & MS Excel and PowerPoint
  • Reside in New York State

Preferred Qualifications:

  • 5+ years of experience conducting investigations
  • 5+ years of experience working in a government or healthcare environment (i.e. public sector) with experience in compliance
  • Certified Professional coder (CPC)
  • Certified Fraud Examiner (CFE)
  • Experience with financial or fraud investigations
  • Experience working with State and federal law enforcement including, but not limited to NYS Dept of Financial Services, NYS Depts of Health and Education, NYS Attorney General, NYS Inspector General, NYS District Attorneys, US Department. of Justice, HHS-OIG and others
  • Working experience with HIPAA, the Empire Plan Benefit Plan, Medicare and / or Medicaid regulations
  • Experience with the legal process, comfortable being deposed or testifying , as needed

Soft Skill Requirements

  • Possess solid investigative, analytical, communication, and writing skills.
  • Possess the ability to manage a high workload, and to handle sensitive, complex, or escalated issues
  • Adept at understanding complex concepts and situations
  • Ability to adapt in a dynamic and high-growth environment
  • Exceptional analytical, organizational, time management, and problem solving skills
  • Superior oral, written communication and interpersonal skills

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.