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.