Santa Barbara, CA26 days ago
li>Lead the development, facilitation, coordination, and evaluation of FWA initiatives and day-to-day operations, with duties including but not limited to: Develops, implements, maintains and reviews FWA procedures, workflows, templates documentation required for investigations, investigation-related correspondence, and CAPs; Maintains a secure centralized system for FWA case information management, ensuring an accurately maintained FWA case log; Maintains FWA report/activity reminder systems and notifying staff of deliverables; Prepares reports to committees/workgroups, state agencies, and law enforcement, as needed; Informs Compliance leadership of instances of non-compliance identified in/through CenCal Health operations, as needed; Develops and facilitates FWA training, education and awareness activities; Prepares for internal/external audits, and audit finding responses and corrective action plans; Coordinates with departments to modify existing and/or identify and implement new internal controls including but not limited to auditing and monitoring to strengthen the health plan's FWA activities. Perform investigations into potential/actual FWA, with duties including but not limited to:
- Receiving and investigating allegations/incidents of FWA from external and internal sources; Leads and manages the intake referral from internal and external sources and developing leads presented to Compliance to assess and determine whether potential fraud, waste, or abuse is corroborated by evidence.