Manager, Compliance Investigations

Option Care Health•Itasca, IL

2d•$112,440 - $187,407

About The Position

The Manager, Compliance Operations & Investigations supports Option Care Health’s compliance investigation program by managing investigations from intake through resolution, including allegations received through established reporting channels. The role conducts root cause analyses, helps implement and track corrective actions, identifies trends and systemic issues, and provides guidance and reporting to stakeholders. The Manager collaborates with cross-functional partners to route matters appropriately, resolve issues efficiently, mitigate compliance risk, and supports the maintenance of investigation, corrective action, and related compliance polies and procedures in alignment with applicable laws and regulations.

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

Nice To Haves

Certified in investigation tactics, interviewing, fraud examination, and/or compliance (e.g., CFE, AHFI, CHC, CPCO)
Advanced degree (e.g., JD, MBA, MPH) or clinical certification
At least 2 years of direct experience in a compliance role for home infusion services, pharmacy, nursing, or large payor organization..
At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care regulatory requirements.
Experience using common third-party software solutions for Compliance and Privacy program management of incidents, investigations, monitoring and exclusion screening (such as Navex, internal case management systems, etc.)

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.