Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse

The Director, Compliance on Special Investigations and Fraud, Waste and Abuse (FWA) is responsible for directing L.A. Care Health Plan's enterprise special investigations unit (SIU) and FWA program. The Director oversees internal and external investigations into potential misconduct, regulatory violations, and fraudulent activity while ensuring compliance with federal and state regulatory requirements. The Director provides strategic direction, operational leadership, and subject matter expertise to safeguard L.A. Care's integrity, protect member trust, and mitigate financial and reputational risks. This position leads investigative governance across the enterprise, coordinating with internal stakeholders and external regulators to ensure timely, thorough, and effective resolution of investigative matters. This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Leadership and Program Oversight :

• Lead L.A. Care's Special Investigations Unit (SIU) in overseeing the internal and external investigations into fraud, waste, abuse, and compliance violations.
• Drive the design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program, ensuring compliance with Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and state / federal requirements.
• Ensure effective case intake, triage, investigation, tracking, and resolution processes, including referral to law enforcement, regulators, or external entities as needed.
• Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response.

Investigations and Regulatory Engagement :

Risk Management and Oversight :

Collaboration and Culture :

Education Required :

Experience Required :

Skills Required :

Licenses / Certifications :

Required Training :

Additional Information :

Salary Range Disclaimer : The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. L.A. Care offers a wide range of benefits including + Paid Time Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical, Dental and Vision + Wellness Program + Volunteer Time Off (VTO)