Audits and Investigations Operations Manager

Overview

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives.

Founded in 1986, PCG employs approximately 2,000 professionals throughout the . all committed to delivering solutions that change lives for the better.

The firm is a member of a family of companies with experience in all 50 states, and clients in six Canadian provinces and Europe.

PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit .

Responsibilities

Responsible for managing the day-to-day audit and investigations of Fee-for-Service and Managed Care Oversight audits.

The manager shall support the Agency with its collaboration with CMS Program Integrity Contractor’s audits and investigations efforts.

This role is responsible to coordinate and make appropriate referrals to managed care entities, the Medicaid Fraud & Control Unit and other local, federal, state entities for further action.

• Provides project management and leadership.
• Responsible for the coordination of all project activities within project team, management and the client.
• Manages department staff, anticipating needs, monitoring performance, and making recommendations to senior management.
• Accountable for recruitment, management, and retention of staff.
• Ensures development and maintenance of standard operating procedures.
• Develops and oversees staff training and capacity building efforts
• Oversees quality assurance metrics
• Provides coaching, training, and development for staff, when needed.
• Leads and / or participates in weekly status updates and monthly status reports with clients and project team.
• Manages and track project budget and invoicing.
• Provides ongoing communication with the project oversight panel, including senior staff from government agencies and other key stakeholders / organizations.
• Maintains a positive working relationship with the client.
• Supports project management in program design and identification of needs
• Responsible for ongoing staff training and development, managing quality assurance functions and implement action plans to achieve team goals.

Qualifications

Education

Bachelor's degree or higher, preferably in Business Administration, Public Health, Healthcare Administration, or Public Policy, or other closely related fields preferred;

or equivalent experience

Experience

• 3+ years of relevant work experience.
• Medicaid or other healthcare program integrity experience preferred.
• Direct supervisory or management experience.

Required Skills

• Excellent communication, interpersonal, and client-facing skills.
• Knowledge of healthcare claim data analytics and clinical investigation work.
• Ability to develop reports and assess data to realize and prioritize potential cost savings and recovery opportunities.
• Ability to understand and interpret federal and state laws and regulations.
• Ability to manage a team of clinical investigators and analytic experts and effectively coordinate project tasks and deliverables.
• Ability to assess and delegate case workload to appropriate clinicians and investigators.
• Ability to effectively communicate project status, issues, and information to the client.
• Ability to successfully monitor quality of data analytic and clinical review activities.
• Strong Microsoft Office applications skills; preferably with Excel, Word, Outlook, and Access.

Working Conditions :

• Hybrid Remote Schedule (1-2 days in office)
• Candidates MUST live within 2 hour driving distance to the Des Moines, IA office
• Candidates MUST be a resident of Iowa
• Travel may be required up to 10% for client meetings

Remote Work Statement :

This position is a remote, work from home position. PCG is a remote-friendly organization and is committed to creating a culture where remote work remains a vital part of the company’s success.

To be successful in a remote work role at PCG, you must :

• be available during your set working hours.
• have a safe, private, and distraction-free environment in which to complete your work, and
• be able to give your full attention to the completion of your PCG job duties.

Some travel to the office or elsewhere may be required for team meetings, client meetings, etc.

We are accepting applications on an ongoing basis until filled.

LI-remote

Compensation

Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience.

As required by applicable law, PCG provides the following reasonable range of compensation for this role : $80,000-$100,000 and a potential discretionary bonus of up to 10%.

In addition, PCG provides a range of benefits for this role, including medical and dental care benefits, 401k, PTO, parental leave, bereavement leave.

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion.

We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences.

At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications.

We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and / or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law.

PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.