High-Risk Provider Management Supervisor (WMS2/DAIO)

High-Risk Provider Management Supervisor (WMS2/DAIO)

Salary

$81,348.00 - $113,880.00 Annually

Location

Thurston County - Olympia, WA

Job Type

Full Time - Permanent

Remote Employment

Remote Optional

Job Number

2026-08559

Department

Health Care Authority

Division

DAIO

Opening Date

10/13/2026

Closing Date

10/27/2026 11:59 PM Pacific

• Description
• Benefits
• Questions

Description

High-Risk Provider Management Supervisor

This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.

All HCA employees are required to be Washington state residents upon their first day of employment.

The Opportunity

Protect Washingtons Medicaid program and the people it serves. The Division of Audit, Integrity, and Oversight (DAIO) is seeking a High-Risk Provider Management Supervisor to lead HCAs new High-Risk Provider Management Team. This team is HCAs primary authority for overseeing high- and moderate-risk Medicaid providers, administering enhanced oversight mechanisms, and developing provider termination and disenrollment recommendations. You will set the policies and procedures that guide consistent risk determinations and enforcement actions, and coordinate with managed care organizations, sister agencies, and law enforcement to bring accountability and transparency to how Medicaid funds are spent.

Key Responsibilities Include

• Supervise a team of professional staff responsible for enhanced oversight, monitoring, and site visits of high- and moderate-risk Medicaid providers.
• Assign and elevate provider risk levels, initiate required fingerprint-based criminal background checks, and enforce regulatory deadlines.
• Authorize and plan unannounced site visits, develop field task orders and standard operating procedures, and manage the site visit teams budget of approximately $200,000 a year.
• Oversee daily screening of providers against the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM), along with reviews of billing patterns, geographic data, and corporate histories.
• Identify red flags, escalate concerns to leadership or HCAs Special Investigations Unit, and coordinate with CMS, law enforcement, the Medicaid Fraud and Abuse Division, and other oversight entities.
• Develop legally defensible denial and termination letters, evidence packets, and recommendations that support risk decisions during provider appeal hearings.
• Partner with Provider Enrollment on revalidation schedules and on provider termination and enrollment policy recommendations.
• Develop policies and procedures for temporary provider moratoria under 42 CFR 455.470.
• Analyze legislation affecting program integrity, advise executive leadership, and contribute to WAC development and agency-wide process improvements.

Why You'll Love This Role

• Youll be on the front line of protecting Medicaid clients and public dollars, influencing the integrity of billions of dollars in services.
• Youll help build a new team from the ground up, setting the practices and standards it will rely on for years to come.
• Youll work alongside federal partners, law enforcement, and sister agencies on complex cases where your judgment makes a real difference.
• Youll lead a dedicated team while working remotely, with alternative work schedules available based on business needs.

What You Bring

You are a steady, detail-oriented leader who meets your commitments, works independently, and stays focused under pressure, making sound decisions even when there is no precedent to follow. You deal with others in a straightforward and honest way, maintain confidentiality, and support agency values. You bring strong interpersonal skills, respond to questions and concerns with professionalism and care, and hold yourself and your team to a high standard of accuracy and continuous quality improvement. You coach your staff in ways that build a strong culture of compliance.

Required Qualifications

Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.

Regulatory Compliance & Legal Mastery

• Federal & State Medicaid Regulation Expertise: Master-level knowledge of health care compliance frameworks, specifically 42 CFR Part 455 (Program Integrity in Medicaid), including 42 CFR 455.470 regarding provider enrollment moratoria.
• Legislative Analysis & Policy Formulation: Demonstrated ability to dissect complex bills and federal legislation, project their operational impacts, advise executive leadership on strategic trade-offs, and translate statutory mandates into actionable Standard Operating Procedures (SOPs).
• Evidentiary Documentation & Legal Defensibility: Demonstrated expertise in authoring administrative summaries, chronological evidence packets, and formal enrollment denial or termination letters that are technically rigorous and legally defensible during provider appeals and hearings.

Risk Management & Investigative Oversight

• Categorical Risk Assessment & Profiling: Demonstrated advanced capabilities in provider risk stratification (Limited, Moderate, High), identifying behavioral red flags, and utilizing data points (geographical data, billing patterns, corporate histories) to confirm provider profiles.
• Background Screening & Enforcement Workflows: Demonstrated mastery of orchestrating mandatory fingerprint-based criminal background checks (FCBC), managing strict regulatory timelines, and executing enforcement mechanisms for non-compliance.
• Sanction Screening Integration: Proficiency in managing daily high-volume data-matching workflows against federal databases, specifically the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM).

Field Operations & Resource Management

• Tactical Field Supervision: Demonstrated competency in designing, budgeting, and executing unannounced physical site visits. This includes generating targeted investigator task orders, structural checklists, and maintaining strict behavioral and safety standards for field staff.
• Audit Readiness & Digital Governance: Demonstrated mastery of maintaining meticulous, structured, and auditable digital case files that can withstand scrutiny from federal auditors or law enforcement.

Strategic Collaboration & High-Level Leadership

• Cross-Agency & Law Enforcement Liaison: Proven ability to interface and coordinate joint efforts with heavy-hitting external oversight bodies, including the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit (MFCU), Unified Program Integrity Contractors (UPIC), and Recovery Audit Contractors (RAC).
• Inter-Organizational Streamlining: Demonstrated skills in aligning strategies across Managed Care Organizations (MCOs), sister divisions, and Provider Enrollment units to build complex prioritization schedules (e.g., provider revalidation cycles).
• Coaching & Human Capital Development: Expert mentorship capabilities to upskill section staff, foster a culture of compliance, and lead agency-wide process improvement initiatives alongside senior executives.

Required Competencies

• Equity lens - All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
• The ability to take action to learn and grow - You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you've learned to continuously improve how you work and serve others.
• The ability to take action to meet the needs of others - You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.

Preferred Qualifications

While these are not required, having them may help you stand out as an applicant.

• Supervisory experience, including conducting employee performance reviews.Demonstrated ability to problem-solve, prioritize workloads, meet deadlines, and provide independent strategic direction and decision-making.

• A bachelors or masters degree in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics, or a closely allied field.

• A law degree from an accredited college or university approved by the Washington State Bar Association.

Demonstrated expert-level experience in the administration of Medicaid funds and expenditures, or experience working with Medicaid or the behavioral health industry.

• Ability to clearly communicate complex information, verbally and in writing, to a non-technical audience.

About the Division of Audit, Integrity, and Oversight (DAIO)

The Division of Audit, Integrity, and Oversight (DAIO) is within the Office of the Chief of Staff (COS) of the Health Care Authority and provides support to all HCA divisions at all employee levels. The goal of DAIO is to combat fraud, waste, and abuse in HCA medical and behavioral health programs, ensuring HCAs programs operate at optimal fidelity and protecting state and federal funds.

Supplemental Information

The Washington State Health Care Authority

Better Health. Better Care. A Healthier Washington.

At HCA, we work to ensure people across Washington have the opportunity to be as healthy as possible. As the State's largest health care purchaser and behavioral health authority, HCA serves nearly 3 million Washington residents through Apple Health (Medicaid), Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs, and behavioral health services. Through this work, HCA purchases and coordinates care coverage, supports behavioral health prevention, treatment, crisis response, and recovery and helps strengthen access to high-quality care across Washington.

More than a benefits package

We want our employees to have the support, flexibility, and benefits they need to do their best work and build a career that works for their life. As a Washington State HCA employee, you'll have access to a comprehensive benefits package that supports your health, financial well-being, and work-life balance. Our benefits are designed to support you today while helping you plan for the future. Learn more about why HCA by visiting the Voices of HCA and the "Who we are" section of our website.

Your total compensation is more than your paycheck

• Remote work and flexible schedules
• Medical, dental, vision, and basic life insurance
• Paid vacation, sick leave, and 12 paid holidays
• Paid Family and Medical Leave (PFML)
• Retirement options to plan for the future
• Training and professional development opportunities
• Employee wellness programs
• Learn more about Washington State Employee Benefits

Work Location and Schedule

This is a full-time 40-hour-per-week remote position. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs and supervisor approval. In this role you will regularly collaborate with colleagues, agency leaders, state and federal partners, and other external partners or customers. Occasional travel may be required for meetings, training, or other business needs. All employees are required to report to our Olympia office on their first and final day of employment.

Our commitment to an inclusive workplace

The Health Care Authority is an equal opportunity employer. We are committed to creating a workplace where employees are respected, included, and supported in bringing their experiences, perspectives, and ideas to work.

Our commitment to inclusion is reflected in how we work together and serve the people of Washington. HCA also supports five voluntary employee led Employee Resource Groups (ERGs), which create opportunities for connection, community, learning, and professional growth.

Application Directions

To be considered, you must complete the online application in full and submit all required materials. Incomplete applications or applications missing required materials will not be considered. When completing your application, please include the following required materials:

• Cover letter: describing your qualifications for this specific position
• Resume: that details your applicable experience and education.
• Three (3) professional references: References must be entered directly into the designated references section of your application. We require 3 professional references including at least one current or recent supervisor.

We encourage you to apply! If you meet the required qualifications for this position; we want to hear from you. Desired qualifications describe additional experience, knowledge or skills that may be helpful in the role, but they are not required to be considered for the position. We welcome applicants with different backgrounds, experiences, identities, and perspectives.

Veterans

We value the experience and skill veterans bring to the workforce and encourage veterans, transitioning service members, and military spouses to apply. Eligible veterans may qualify for veterans' preference in accordance with Washington State Law. If you are claiming veterans' preference, you must attach your applicable DD-214 documentation to your application. Please redact your social security number, date of birth, and any other sensitive information before uploading and attaching the document.

Need accommodations or have questions? If you have questions, need assistance with the application process, require an accommodation, or would like to request this posting in an alternative format, please contact Lisa Fleming, Human Resources Consultant (Recruiter) at HCAjobs@hca.wa.gov and reference the recruitment title and job number in the subject line.

Technical Support: Reach out to NEOGOV directly at 1-855-524-5627 for technical support and login issues.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify is a registered trademark of the U.S. Department of Homeland Security.

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More than Just a Paycheck!

Employee benefits are not just about the kind of services you get, they are also about how much you may have to pay out of pocket. Washington State offers one of the most competitive benefits packages in the nation.

We understand that your life revolves around more than just your career. Like everyone, your first priority is ensuring that you and your family will maintain health and financial security. Thats why choice is a key component of our benefits package. We have a selection of health and retirement plans, paid leave, staff training and other compensation benefits that you can mix and match to meet your current and future needs.

Read about our benefits:

The following information describes typical benefits available for full-time employees who are expected to work more than six months. Actual benefits may vary by appointment type or be prorated for other than full-time work (e.g. part-time); view the job posting for benefits details for job types other than full-time.

Note: If the position offers benefits which differ from the following, the job posting should include the specific benefits.

Insurance Benefits

Employees and their families are covered by medical (including vision), dental and basic life insurance. There are multiple medical plans with affordable monthly premiums that offer coverage throughout the state.

Staff are eligible to enroll each year in a medical flexible spending account which enables them to use tax-deferred dollars toward their health care expenses. Employees are also covered by basic life and long-term disability insurance, with the option to purchase additional coverage amounts.

To view premium rates, coverage choice in your area and how to enroll, please visit the Public Employees Benefits Board (PEBB) website. The Washington Wellness program from the Health Care Authority works with PEBB to support our workplace wellness programs.

Dependent care assistance allows the employee to save pre-tax dollars for a child or elder care expenses.

Other insurance coverage for auto, boat, home, and renter insurance is available through payroll deduction.

The Washington State Employee Assistance Program promotes the health and well-being of employees.

Retirement and Deferred Compensation

State Employees are members of the Washington Public Employees Retirement System (PERS). New employees have the option of two employer contributed retirement programs. For additional information, check out the Department of Retirement Systems web site.

Employees also have the ability to participate in the Deferred Compensation Program (DCP). This is a supplemental retirement savings program (similar to an IRA) that allows you control over the amount of pre-tax salary dollars you defer as well as the flexibility to choose between multiple investment options.

Social Security

All state employees are covered by the federal Social Security and Medicare systems. The state and the employee pay an equal amount into the system.

Public Service Loan Forgiveness

If you are employed by a government or not-for-profit organization, and meet the qualifying criteria, you may be eligible to receive student loan forgiveness under the Public Service Loan Forgiveness Program.

Holidays

Full-time and part-time employees are entitled to paid holidays and one paid personal holiday per calendar year.

Note: Employees who are members of certain Unions may be entitled to additional personal leave day(s), please refer to position specific Collective Bargaining Agreements for more information.

Full-time employees who work full monthly schedules qualify for holiday compensation if they are employed before the holiday and are in pay status for at least 80 nonovertime hours during the month of the holiday; or for the entire work shift preceding the holiday.

Part-time employees who are in pay status during the month of the holiday qualify for the holiday on a pro-rata basis. Compensation for holidays (including personal holiday) will be proportionate to the number of hours in pay status in the month to that required for full-time employment, excluding all holiday hours. Pay status includes hours worked and time on paid leave.

Sick Leave

Full-time employees earn eight hours of sick leave per month. Overtime eligible employees who are in pay status for less than 80 hours per month, earn a monthly proportionate to the number of hours in pay status, in the month to that required for full-time employment. Overtime exempt employees who are in pay status for less than 80 hours per month do not earn a monthly accrual of sick leave.

Sick leave accruals for part-time employees will be proportionate to the number of hours in pay status, in the month to that required for full-time employment. Pay status includes hours worked, time on paid leave and paid holiday.

Vacation (Annual Leave)

Full-time employees accrue vacation leave at the rates specified in WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA). Full-time employees who are in pay status for less than 80 nonovertime hours in a month do not earn a monthly accrual of vacation leave.

Part-time employees accrue vacation leave hours in accordance with WAC 357-31-165(1) or the applicable collective bargaining agreement (CBA) on a pro rata basis. Vacation leave accrual will be proportionate to the number of hours in pay status, in the month to that required for full-time employment.

Pay status includes hours worked, time on paid leave and paid holiday.

As provided in WAC 357-58-175, an employer may authorize a lump-sum accrual of vacation leave or accelerate the vacation leave accrual rate to support the recruitment and/or retention of a candidate or employee for a Washington Management Service position. Vacation leave accrual rates may only be accelerated using the rates established WAC 357-31-165.

Note: Most agencies follow the civil service rules covering leave and holidays for exempt employees even though there is no requirement for them to do so. However, agencies are required to adhere to the applicable RCWs pertaining holidays and leave.

Military Leave

Washington State supports members of the armed forces with 21 days paid military leave per year.

Bereavement Leave

Most employees whose family member or household member dies, or for loss of pregnancy, are entitled to five (5) days of paid bereavement leave. In addition, the employer may approve other available leave types for the purpose of bereavement leave.

Additional Leave

Leave Sharing

Parental Leave

Family and Medical Leave Act (FMLA)

Leave Without Pay

Please visit the State HR Website for more detailed information regarding benefits.

Updated 01-07-2026

01

I acknowledge that I have included at least three references, and that I have uploaded a cover letter and resume in the attachments section of my application.

• Yes
• No

02

If hired for this position, do you currently possess required documents to allow you to legally work within the United States? The attached link lists acceptable documents: https://www.uscis.gov/i-9-central/form-i-9-acceptable-documents

• Yes
• No

03

Will you require sponsorship for an employment-related immigration benefit, either now or in the future?

• Yes
• No

04

How would you rate your ability to to dissect complex bills and federal legislation, project their operational impacts, advise executive leadership on strategic trade-offs, and translate statutory mandates into actionable Standard Operating Procedures (SOPs)?

• a. None: I do not have the ability to perform this task.
• b. Basic Familiarity: I have limited ability to perform this task. I can complete limited or basic aspects of the work with close guidance and would need additional support to perform more complex or unfamiliar assignments successfully.
• c. Able and Capable: I have the ability to successfully perform this task in a variety of routine and moderately complex work situations with minimal guidance.
• d. Advanced Ability: I have a high level of ability and can successfully perform this task in routine, complex, or unfamiliar situations. I can adapt my approach to address challenging circumstances, solve difficult problems, and serve as a resource to others when needed.

05

How would you rate your ability to perform provider risk stratification, identifying behavioral red flags, and utilizing data points (geographical data, billing patterns, corporate histories) to confirm provider profiles?

• a. None: I do not have the ability to perform this task.
• b. Basic Familiarity: I have limited ability to perform this task. I can complete limited or basic aspects of the work with close guidance and would need additional support to perform more complex or unfamiliar assignments successfully.
• c. Able and Capable: I have the ability to successfully perform this task in a variety of routine and moderately complex work situations with minimal guidance.
• d. Advanced Ability: I have a high level of ability and can successfully perform this task in routine, complex, or unfamiliar situations. I can adapt my approach to address challenging circumstances, solve difficult problems, and serve as a resource to others when needed.

06

How would you rate your ability to Proven ability to interface and coordinate joint efforts with heavy-hitting external oversight bodies, including the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit (MFCU), Unified Program Integrity Contractors (UPIC), and Recovery Audit Contractors (RAC)?

• a. None: I do not have the ability to perform this task.
• b. Basic Familiarity: I have limited ability to perform this task. I can complete limited or basic aspects of the work with close guidance and would need additional support to perform more complex or unfamiliar assignments successfully.
• c. Able and Capable: I have the ability to successfully perform this task in a variety of routine and moderately complex work situations with minimal guidance.
• d. Advanced Ability: I have a high level of ability and can successfully perform this task in routine, complex, or unfamiliar situations. I can adapt my approach to address challenging circumstances, solve difficult problems, and serve as a resource to others when needed.

07

How would you rate your ability to upskill section staff, foster a culture of compliance, and lead agency-wide process improvement initiatives alongside senior executives?

• a. None: I do not have the ability to perform this task.
• b. Basic Familiarity: I have limited ability to perform this task. I can complete limited or basic aspects of the work with close guidance and would need additional support to perform more complex or unfamiliar assignments successfully.
• c. Able and Capable: I have the ability to successfully perform this task in a variety of routine and moderately complex work situations with minimal guidance.
• d. Advanced Ability: I have a high level of ability and can successfully perform this task in routine, complex, or unfamiliar situations. I can adapt my approach to address challenging circumstances, solve difficult problems, and serve as a resource to others when needed.

08

How would you describe your expertise in in authoring administrative summaries, chronological evidence packets, and formal enrollment denial or termination letters that are technically rigorous and legally defensible during provider appeals and hearings?

• a. None: I have little or no knowledge or experience in this area.
• b. Basic Understanding: I have foundational knowledge and some experience in this area.
• c. Expertise: I have substantial knowledge and experience and can effectively apply my expertise in this area.
• d. Advanced Expertise: I have advanced, specialized knowledge and extensive experience and can apply my expertise in complex situations and serve as a resource to others.

09

How would you describe your supervisory experience, including conducting employee performance reviews?

• a. No Experience: I have little to no experience performing this work and have not applied it as part of my job responsibilities.
• b. Basic Familiarity: I have limited exposure to this work and may have performed related tasks occasionally or as part of a broader role but have not developed substantial hands-on experience.
• c. Experienced: I have substantial, hands-on experience performing the work as a regular part of my job responsibilities and I have developed the practical knowledge and skills needed to apply them effectively in a variety of work situations.
• d. Advanced Experience: I have extensive experience leading, directing, improving, or providing strategic oversight for this work, including influencing decisions, mentoring others, or guiding complex or high-impact initiatives, as appropriate to the position.

10

How would you describe your experience in maintaining meticulous, structured, and auditable digital case files that can withstand scrutiny from federal auditors or law enforcement?

• a. No Experience: I have little to no experience performing this work and have not applied it as part of my job responsibilities.
• b. Basic Familiarity: I have limited exposure to this work and may have performed related tasks occasionally or as part of a broader role but have not developed substantial hands-on experience.
• c. Experienced: I have substantial, hands-on experience performing the work as a regular part of my job responsibilities and I have developed the practical knowledge and skills needed to apply them effectively in a variety of work situations.
• d. Advanced Experience: I have extensive experience leading, directing, improving, or providing strategic oversight for this work, including influencing decisions, mentoring others, or guiding complex or high-impact initiatives, as appropriate to the position.

11

How would you describe your proficiency in using in managing daily high-volume data-matching workflows against federal databases, specifically the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM)?

• a. None: I have little to no proficiency in this skill or area.
• b. Basic Understanding: I have a limited understanding of the fundamental concepts and would require close guidance or reference materials when performing work.
• c. Proficient: I have developed practical knowledge and skill through regular application and can effectively use this knowledge or skill to perform a range of routine and moderately complex work with minimal guidance.
• d. Advanced Proficiency: I have extensive knowledge and skill developed through significant practical application. I can effectively apply this knowledge or skill in complex or unfamiliar situations, adapt to changing circumstances, troubleshoot difficult issues, and serve as a resource to others when needed.

12

How would you describe your proficiency level in in designing, budgeting, and executing unannounced physical site visits? This includes generating targeted investigator task orders, structural checklists, and maintaining strict behavioral and safety standards for field staff.

• a. None: I have little to no proficiency in this skill or area.
• b. Basic Understanding: I have a limited understanding of the fundamental concepts and would require close guidance or reference materials when performing work.
• c. Proficient: I have developed practical knowledge and skill through regular application and can effectively use this knowledge or skill to perform a range of routine and moderately complex work with minimal guidance.
• d. Advanced Proficiency: I have extensive knowledge and skill developed through significant practical application. I can effectively apply this knowledge or skill in complex or unfamiliar situations, adapt to changing circumstances, troubleshoot difficult issues, and serve as a resource to others when needed.

13

How would you describe your proficiency level in aligning strategies across Managed Care Organizations (MCOs), sister divisions, and Provider Enrollment units to build complex prioritization schedules (e.g., provider revalidation cycles)?

• a. None: I have little to no proficiency in this skill or area.
• b. Basic Understanding: I have a limited understanding of the fundamental concepts and would require close guidance or reference materials when performing work.
• c. Proficient: I have developed practical knowledge and skill through regular application and can effectively use this knowledge or skill to perform a range of routine and moderately complex work with minimal guidance.
• d. Advanced Proficiency: I have extensive knowledge and skill developed through significant practical application. I can effectively apply this knowledge or skill in complex or unfamiliar situations, adapt to changing circumstances, troubleshoot difficult issues, and serve as a resource to others when needed.

14

Select which best describes your level of knowledge with of health care compliance frameworks, specifically 42 CFR Part 455 (Program Integrity in Medicaid), including 42 CFR 455.470 regarding provider enrollment moratoria?

• a. None: I have little to no knowledge of this subject.
• b. Basic Awareness: I have a limited understanding of this subject and would need additional guidance to apply it in most work situations.
• c. Knowledgeable: I have a solid understanding of this subjects key concepts and principles and can effectively apply that knowledge in a variety of typical work situations.
• d. Advanced Knowledge: I have a comprehensive understanding of this subject and can apply that knowledge to complex, challenging, or unfamiliar situations. I can analyze issues, make informed decisions, solve problems, and serve as a resource to others when appropriate.

Required Question

Employer State of Washington

Address View Job Posting for Agency Information

View Job Posting for Location, Washington, 98504

Website http://www.careers.wa.gov