Healthcare Investigations Manager
Owns the healthcare compliance hotline investigation function, including intake, triage, HIPAA and security investigations, remediation, exclusion screening, self-disclosures, reporting, and platform administration. The role manages a small team while partnering with Legal, Compliance, IT Security, and Operations.
About the job
Responsibilities
- Own intake, triage, assignment, and investigation of compliance hotline reports.
- Conduct investigations by gathering facts, interpreting policy, analyzing data, handling sensitive matters discreetly, and escalating when necessary.
- Define findings, drive corrective actions and remediation, confirm closure, and maintain audit-ready documentation.
- Perform policy gap analysis and coordinate policy changes with organizational leaders.
- Investigate potential HIPAA and security policy violations in coordination with IT Security.
- Conduct monthly and new-vendor exclusion screenings against federal and state exclusion lists.
- Coordinate self-disclosures and escalations with Legal and compliance leadership.
- Prepare quarterly investigation and disclosure-program reports for senior leadership, the Compliance Committee, and the Board.
- Administer compliance case-management and exclusion-screening platforms, including configuration, user access, and data integrity.
- Manage and develop 2–3 direct reports while remaining hands-on with casework.
Requirements
- Experience running a healthcare investigations or hotline function full-time, preferably in a compliance or regulatory setting.
- Experience investigating HIPAA and security policy violations, ideally with an IT Security team.
- Experience administering a compliance case-management or hotline platform.
- Ability to prepare and present investigation trends and disclosure-program data to senior leadership.
- Strong root-cause analysis, policy gap analysis, and audit-ready documentation skills.
- Familiarity with OIG guidance, particularly Elements 4 and 7.
- Experience managing a small team while handling investigations directly.
- High integrity and effective collaboration across Legal, Compliance, IT Security, and Operations.
Nice to Have
- Certified in Healthcare Compliance (CHC) certification.
Benefits
- Medical, dental, and vision plans.
- Flexible Spending Accounts and Health Savings Accounts.
- Flexible paid time off.
- 401(k) with company match.
- Life insurance and pet insurance.
Skills
Healthcare Compliance, Healthcare Investigations, HIPAA, Security Policies, It Security, Compliance Hotline, Case Management, Root-Cause Analysis, Policy Gap Analysis, Exclusion Screening, Self-Disclosures, Oig Guidance, Data Analysis, Compliance Reporting, Team Management
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