Manager, Special Investigations Unit

HMSA Honolulu, HI Open
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HMSA is looking for Manager, Special Investigations Unit in Honolulu, HI.
This local job opportunity with ID 3631127549 is live since 2026-04-09 21:00:28.
  1. Program Oversight/Leadership for FWA SIU:
    • Provide strategic oversight of the FWA SIU program
    • Ensure compliance with all applicable FWA regulatory requirements
    • Maintain independence and objectivity of SIU investigations
    • Oversee intake, prioritization, and outcomes of investigations
    • Review and approve investigative findings and referrals
    • Escalate significant FWA risks to executive leadership
    • Oversee vendor and delegated FWA/SIU activities
    • Monitor FWA trends, metrics, and program effectiveness
    • Oversee FWA related reporting
    • Support audit readiness and regulatory inquiries
  2. Cross-Functional Team Partnerships:
    • Partner with Compliance to ensure regulatory alignment and audit readiness
    • Collaborate with Medical Management on utilization and clinical FWA risks
    • Coordinate with Provider Relations on provider actions and remediation
    • Work with Finance on recoveries, overpayments, and financial reporting
    • Coordinate with Legal as appropriate on investigations, and enforcement actions
    • Support Operations with FWA education, guidance, and risk mitigation
    • Coordinate with delegated entities and vendors on FWA oversight and reporting
    • Serve as the primary SIU liaison to internal and external stakeholders
  3. Leadership:
    • Selects, trains, develops and organizes staff.
    • Monitors overall inventory of work and prioritizes the staff's work to meet performance standards and authorizes additional resources as needed.
    • Provides feedback and coaching (helping individuals to solve problems/issues on their own) including timely completion of any interim and year-end performance reviews.
  4. Performs all other miscellaneous responsibilities and duties as assigned or directed.
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