Manager, Compliance Investigations
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Manager overseeing compliance investigations at Option Care Health, supporting the compliance department's investigation program and addressing fraud, waste, abuse, and compliance concerns.
Responsibilities:
- Conduct investigations into fraud, waste, abuse, and other compliance concerns, ensuring thorough, objective analysis and documentation.
- Support management of the company’s confidential Ethics & Compliance Hotline including intake, case management workflow, reporting, analytics, and vendor relationships.
- Maintain accurate case records in the Compliance case management system.
- Develop, implement, and maintain investigation strategies, policies and processes to identify and address potential violations of laws, regulations, and internal policies.
- Collaborate with cross-functional partners to assess, triage, and route investigative matters for appropriate resolution and risk mitigation.
- Consult with Legal on compliance-related legal issues and timely communicate relevant statutory, regulatory or policy changes to business unit leadership.
- Conduct root cause analysis and implement corrective actions.
- Monitor and track remediation completion.
- Prepare and present investigation reports to leadership and regulatory authorities, as necessary.
- Provide guidance on compliance policies, procedures, and best practices and foster a culture of ethical conduct and non-retaliation.
- Maintain current knowledge of relevant healthcare laws and regulations (e.g., HIPAA, Stark Law, Anti-Kickback Statute, and False Claims Act).
- Help ensure investigative practices remain current and compliant.
- Support Compliance activities related to conflict-of-interest disclosure review and response.
- Ensure confidentiality of sensitive business and patient information.
- Maintain records consistent with Option Care Health policy and Compliance Department processes.
- Support compliance integration initiatives with new business models.
Requirements:
- Bachelor’s degree or Associate degree, preferred in healthcare, business, legal, justice , or related field.
- Minimum 4-6 years of progressive experience in investigations, healthcare compliance, or risk management, including at least 2-4 years in a role overseeing or conducting investigations.
- Strong investigative skills and experience, including interviewing, evidence analysis, attention to detail, and good judgment.
- Ability to conduct thorough, objective and complex investigations, analyze complex data sets, and draw actionable conclusions.
- Knowledge of healthcare laws and regulations, including billing and coding, privacy and security, and fraud, waste and abuse (e.g., HIPAA, Anti-Kickback, Stark, Medicare and Medicaid reimbursement).
- Experience assessing compliance with applicable laws, regulations, standards, and internal policies.
- Experience interacting with senior management, legal counsel, federal and state regulators, and law enforcement.
- Excellent communication and interpersonal skills, with the ability to build relationships, influence stakeholders, and clearly communicate investigative findings.
- Experience identifying operational issues and recommending effective solutions.
- Experience managing multiple investigations simultaneously, prioritizing work effectively, and providing regular status updates to leadership.
- Strong analytical, problem-solving, and critical-thinking skills.
- Self-motivated, accountable for personal growth, and supportive of others’ development, while fostering an inclusive team environment and engaging in continuing education opportunities and connection.
- Ability to handle sensitive and confidential information with professionalism.
- Intermediate level skill in Microsoft Excel, Microsoft Word and Microsoft PowerPoint.
Benefits:
- Medical, Dental, & Vision Insurance
- Paid Time off
- Bonding Time Off
- 401K Retirement Savings Plan with Company Match
- HSA Company Match
- Flexible Spending Accounts
- Tuition Reimbursement
- myFlexPay
- Family Support
- Mental Health Services
- Company Paid Life Insurance
- Award/Recognition Programs
Similar Jobs
Senior Manager, Regulatory Submissions
Senior Regulatory Submissions Manager overseeing the operational aspects of regulatory submissions for U.S. and international agencies. Ensuring high-quality submissions delivered on-time in compliance with regulations.
Manager, Government Program Compliance – Risk Adjustment
Compliance Manager focused on Government Program regulations and overseeing operational compliance. Collaborating with multiple teams to manage risks and ensure adherence to laws for HCSC.
Manager, Government Program Compliance, Pharmacy
HCSC is looking for a Manager to oversee Government Program Compliance in healthcare regulations. Focused on Medicare and Medicaid, evaluating compliance, risks, and reporting.
Government Programs Compliance Analyst
Compliance Analyst supporting HCSC Government Programs in data analysis, trending, and regulatory compliance. Involvement in monitoring corrective actions and sales activities for healthcare compliance.
Marketing Associate – SMS Compliance
A2P & Email Deliverability Operations Specialist managing SMS/email frameworks for Moxie's provider network. Ensuring provider communications are effective and streamlined.
Compliance Manager – Transparency
Compliance Manager for Summit Therapeutics managing transparency reporting and compliance activities across healthcare providers and organizations. Enhancing corporate compliance program with stakeholders' collaboration and adherence to regulations.
GRC Consultant – Sales
GRC Consultant focusing on B2B SaaS sales at HiScout GmbH. Contributing to sales strategies in compliance and IT security markets with remote work.
Senior GRC Engineer
Senior GRC Engineer at Workstreet managing cybersecurity compliance for clients and leading a team of analysts. Delivering exceptional client experiences while overseeing projects in various regulatory frameworks.
TPA and Insurance Regulatory Licensing Specialist
TPA and Insurance Regulatory Licensing Specialist managing licensing applications for compliance within a diverse regulatory environment. Requires a minimum of 3 years of experience in licensing and regulatory monitoring.
Senior Regulatory Publishing Associate
Senior Regulatory Ops Associate overseeing regulatory document management for clinical trials at ICON healthcare intelligence. Collaborating cross-functionally to optimize regulatory processes for innovative therapies.
Manager, Regulatory Compliance
Regulatory Compliance Manager responsible for overseeing product safety and compliance for Eos Energy's Z3 batteries. Collaborating with engineering, clients, and regulatory bodies to maintain safety standards.
Regulatory Affairs Consultant – Clinical Regulatory Affairs
Regulatory Affairs Consultant guiding clinical studies through regulatory processes for Parexel. Collaborating with cross-functional teams to ensure compliant and efficient trial execution.
GRC Engineer
GRC Engineer at WorkOS managing compliance, risk, and customer trust programs. Leading initiatives for certifications and automating GRC processes in a remote environment.
Specialist, Regulatory & Site Activation
Specialist in Regulatory & Site Activation at Worldwide Clinical Trials in Australia. Responsible for driving regulatory submissions with a focus on quality and compliance.
Head of Compliance
Head of Compliance for beqom, ensuring global compliance and governance while leading a high-impact team. Focused on regulatory frameworks in a dynamic SaaS company.
Compliance Officer
Compliance Officer overseeing projects ensuring adherence to laws and regulations at Codekeeper. Leading compliance initiatives and managing project timelines in a fast-paced, remote-first environment.
Senior Regulatory Policy and Intelligence Manager
Regulatory Manager at Amgen driving alignment on regulatory policies and engaging with external stakeholders. This role requires in-depth knowledge of legislation and strong communication skills.
SAP GRC Consultant – Senior
SAP GRC Senior Consultant at Mollica IT enhancing security and compliance measures through SAP solutions. Collaborating in project implementations and multi-functional governance activities.
Early Development Global Regulatory Lead
Early Development Global Regulatory Lead at argenx focusing on regulatory strategies and patient-centric development pathways. Overseeing regulatory affairs to support early asset progression in biopharmaceuticals.
IT Specialist, SOX Compliance, SAP GRC
Specialist IT SOX and SAP GRC Compliance ensuring integrity and compliance of key reports. Support for financial and IT control environments while contributing to SOX processes in a biotech company.