Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary* The selected candidate preferably resides in NY, NJ, OH, MI. - Leads a team of investigators to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with state regulations mandating fraud plans and reporting. - Leads a team in the planning and execution of investigations of acts of healthcare fraud and abuse by both members and providers. - Provides direction and counsel on the handling of cases and facilitates issue resolution. - Assists in identifying resources and best course of action to take in a timely and effective manner. - Conducts case reviews and provides feedback to investigators on completeness and quality of the investigation. - Conducts team member evaluations and provides performance feedback to staff on an ongoing basis. - Manages workload of their team to ensure equitable distribution and exposure to wide range of cases to match current skills and development needs. - Assesses training needs and works with SIU Director on development plans for team members. - Develops and maintains close working relationships with federal, state, and local law enforcement agencies in the investigation and prosecution of acts of healthcare fraud and abuse. - Participates in state meetings. - Ensures compliance with contractual requirements. - Coordinates and collaborates with compliance and senior leadership. - Contributes to the development and delivery of educational awareness and training programs that meet or exceed those required by state mandates. - Participates in federal and state audits. *Required Qualifications* - Minimum of three years managing healthcare fraud, waste and abuse investigations and audits. Medicaid experience a plus. - 7 years of investigative work experience required. - Experience working with state and law enforcement partners. - Strong verbal and written communication skills. - Ability to interact with different groups of people at different levels and provide assistance on a timely basis. - Proficient in researching information and identifying information resources. - Proficiency in Word, Excel, MS Outlook products. - Ability to travel up to 10% (approx. 2-3x per year, depending on business needs) *Preferred Qualifications* - Credentials such as a certification from the Association of Certified Fraud Examiners (CFE) or an accreditation from the National Health Care Anti-Fraud Association (AHFI) - Billing and Coding certifications such as CPC (AAPC) - Knowledge of Aetna's policies and procedures - Knowledge of Medicaid/Medicare plans. *Education * *- *Bachelor's degree or equivalent experience *Pay Range* The typical pay range for this role is: $54,300.00 - $139,200.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit [jobs.CVSHealth.com/benefits](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 06/03/2024
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