CVS Health · 11 hours ago

Manager, Investigations - FEP MQ - Federal Employee Program (FEP) Managed Care Quality (MQ)

Phoenix, AZ

Full-time

Remote

Mid, Senior Level

$54K/yr - $119K/yr

5+ years exp

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Responsibilities

Oversee and manage investigations related to fraud, waste, and abuse within the Federal Employee Program (FEP) Managed Care Quality (MQ) department.

Lead efforts to detect and investigate instances of fraud and abuse within the FEP MQ program.

Develop and implement proactive measures, such as data analytics, claims reviews, and other investigative techniques, to identify suspicious patterns or practices that may indicate fraudulent activities.

Assist in the development of investigation plans and strategies to effectively address potential fraud or abuse cases.

Collaborate with various internal departments, such as legal, compliance, claims, and provider relations, to ensure a coordinated approach to FEP MQ investigations.

Ensure quality documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information to facilitate transparency.

Coach an investigation team through the documentation of investigation activities, including evidence collection, witness statements, case files, and other relevant information.

Manage team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

Contribute to the development and enhancement of policies, procedures, and protocols related to FEP MQ investigations.

Qualification

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Investigative workData analyticsMicrosoft Office SuiteHealthcare experiencePharmacy Benefit Manager (PBM)Training peersPresenting to leadershipTeam management