Special Investigations Unit Director jobs in Riverside, CA

Special Investigations Unit Director oversees the operations for conducting thorough investigations. Develops the strategies for the cross-functional detection and elimination of fraudulent behavior. Being a Special Investigations Unit Director prepares investigative reports and analyses that pertinent to evidence obtained during investigations. May coordinate with outside sources such as law enforcement agencies, and external audit, etc. Requires a bachelor's degree. Additionally, Special Investigations Unit Director typically reports to top management. The Special Investigations Unit Director manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Special Investigations Unit Director typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)

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Special Investigations Unit Medical Reviewer
  • Inland Empire Health Plan
  • Rancho Cucamonga, CA FULL_TIME
  • Overview

    What you can expect! 

     

    Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

     

    Under general supervision, the Special Investigations Unit Medical Reviewer (SIU Medical Reviewer) performs reviews of medical records and healthcare claims to substantiate or refute the accuracy and compliance with federal and state regulations and contractual requirements of codes billed to identify coding errors and billing discrepancies in relation to incidents of suspected healthcare fraud, waste, and abuse (FWA) reported to IEHP’s Compliance Special Investigations Unit (SIU). 

    Additional Benefits

    Perks

     

     

    IEHP is not only committed to healing and inspiring the human spirit of our Members; we also aim to match our Team Members with the same energy by providing prime benefits and more.

     

    • CalPERS retirement
    • 457(b) option with a contribution match
    • Generous paid time off- vacation, holidays, sick
    • State of the art fitness center on-site
    • Medical Insurance with Dental and Vision
    • Paid life insurance for employees with additional options
    • Short-term, and long-term disability options
    • Pet care insurance
    • Flexible Spending Account – Health Care/Childcare
    • Wellness programs that promote a healthy work-life balance
    • Career advancement opportunities and professional development
    • Competitive salary with annual merit increase
    • Team bonus opportunities

    Qualifications

     

    Education & Experience

     

    • A minimum of two (2) years of experience performing medical reviews of medical records and claims in a healthcare setting
    • Bachelor’s degree in medical billing or medical coding, nursing, healthcare administration, or other related field from an accredited institution required
    • Certified Professional Coder (CPC) required
    • One of the following licenses preferred
    • Possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians
    • Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California BRN

     

    Key Qualifications

    • Strong verbal and written communication, interpersonal skills, critical problem-solving skills, and attention to detail
    • Above average proficiency in the use of technology applications, particularly Excel, Word, and others as necessary

     

    Start your journey towards a thriving future with IEHP and apply TODAY!

    Work Model Location

    Hybrid

    Pay Range

    USD $34.14 - USD $39.57 /Hr.
  • 6 Days Ago

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Senior Special Investigations Unit Medical Reviewer
  • Inland Empire Health Plan
  • Rancho Cucamonga, CA FULL_TIME
  • Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experien...
  • 6 Days Ago

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Special Unit Staff RN - Hospital - DOU/SDU
  • Kaiser Permanente
  • Riverside, CA OTHER
  • Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demons...
  • 4 Days Ago

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SURVEILLANCE INVESTIGATOR - Riverside, CA
  • Advantage Investigations
  • Riverside, CA FULL_TIME
  • Advantage Investigations is the Nation’s only insurance defense investigation firm that invests in the operational capabilities necessary to produce consistent, high-quality results—ultimately helping...
  • 9 Days Ago

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In-Person - Special Education Teacher
  • Special Education Teacher - Tutor Me Education
  • Menifee, CA OTHER
  • Tutor Me Education is reshaping how students learn. We are looking for therapists to provide 1:1 or group instruction to students in Menifee area of California!Here are the details: Location: (In-Pers...
  • Just Posted

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376-3086 PROGRAM SPECIALIST (#376-3085)
  • SPECIAL EDUCATION
  • Hemet, CA FULL_TIME
  • HEMET UNIFIED SCHOOL DISTRICT PROGRAM SPECIALIST - SPECIAL EDUCATION BRIEF DESCRIPTION OF POSITION The program specialist, under the direction of the Director of Special Education, will provide consul...
  • 7 Days Ago

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0 Special Investigations Unit Director jobs found in Riverside, CA area

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Associate Director, RA In Vitro Diagnostics and Companion Diagnostics (Remote)
  • AbbVie, Inc
  • Irvine, CA
  • Company Description AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious he...
  • 3/28/2024 12:00:00 AM

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Mgr, Banquet
  • Great Wolf Resorts, Inc.
  • Garden Grove, CA
  • ** Mgr, Banquet** **Job Category****:** Food & Beverage **Requisition Number****:** MGRBA12857 Showing 1 location **Job ...
  • 3/28/2024 12:00:00 AM

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Manager of Laboratory
  • College Hospital of Costa Mesa
  • Costa Mesa, CA
  • Job Description Job Description Psychiatric hospital in Orange County is looking to hire a Full-Time, Day Shift Manager ...
  • 3/28/2024 12:00:00 AM

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Director of Planning Systems - Remote
  • Monster Energy Company
  • Corona, CA
  • Position Summary: The Director of Planning Systems will have functional responsibility for the supply chain planning cap...
  • 3/27/2024 12:00:00 AM

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Operations Manager/HEP (UEC)
  • California State University
  • San Bernardino, CA
  • Operations Manager/HEP (UEC) Job no: 532489 Work type: Auxiliary Location: San Bernardino - San Bernardino Campus Catego...
  • 3/26/2024 12:00:00 AM

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Business Manager
  • InterDent Service Corporation
  • Orange, CA
  • At Gentle Dental, our Business Managers are committed to and passionate about their office. They ensure that their offic...
  • 3/25/2024 12:00:00 AM

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Director, Cell Therapy GMP Operations
  • HireMinds
  • Loma Linda, CA
  • Director, Cell Therapy GMP Operations Loma Linda, CA Our client is building a state-of-the-art facility for the research...
  • 3/24/2024 12:00:00 AM

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Clinical Documentation Improvement Supervisor - RUHS - Medical Records
  • County of Riverside, CA
  • Riverside, CA
  • ABOUT THE POSITION Riverside University Health System-Medical Center is seeking a Clinical Documentation Improvement Sup...
  • 3/24/2024 12:00:00 AM

Riverside is a city in Riverside County, California, United States, located in the Inland Empire metropolitan area. Riverside is the county seat of the eponymous county and named for its location beside the Santa Ana River. It is the most populous city in the Inland Empire and in Riverside County, and is located about 55 miles (89 km) east of downtown Los Angeles. It is also part of the Greater Los Angeles area. Riverside is the 59th most populous city in the United States and 12th most populous city in California. As of the 2010 Census, Riverside had a population of 303,871. Riverside was fou...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Special Investigations Unit Director jobs
$165,961 to $249,987
Riverside, California area prices
were up 3.0% from a year ago

Special Investigations Unit Director in Newark, NJ
Special Investigators make referrals to agencies of the federal and state government and report evidence of criminal activity to the appropriate law enforcement authority.
December 18, 2019
Special Investigations Unit Director in Stockton, CA
The Chief Investigator of the Special Investigations Unit is assigned to the Department of Health and Human Services and is responsible for overseeing the prevention, detection and investigation of welfare fraud.
January 31, 2020
Special Investigations Unit Director in Omaha, NE
These investigations include the review of documented evidence supporting allegations of unfair methods of competition, unfair and deceptive acts or trade practices and other violations of insurance law and regulations.
January 18, 2020