Hiring: Director, Compliance on Special Investigations Unit and Fraud, Waste and Abuse Company: L.A. Care Health Plan Location: Los Angeles, CA Job Posted Time: 2026-09-14 15:12:25 Target Skills & Keywords : Medicaid, Medicare, Project Management, Risk Management About the job Experience: •At least 7 years of experience in healthcare compliance, fraud investigations, law enforcement, or related field. •At least 5years of experience in leading teams, projects, initiatives, or cross-functional groups. •Demonstrated experience managing complex investigations in a managed care or healthcare environment. Required Skills: •This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. •Lead L.A. Care’s Special Investigations Unit (SIU) in overseeing the internal and external investigations into fraud, waste, abuse, and compliance violations. •Strategically drive design, implementation, and continuous improvement of the Fraud, Waste, and Abuse (FWA) program, ensuring compliance with Centers for Medicare and Medicaid Services (CMS), Department of Health Care Services (DHCS), and state/federal requirements. •Ensure effective case intake, triage, investigation, tracking, and resolution processes, including referral to law enforcement, regulators, or external entities as needed. •Develop and support enterprise policies, procedures, and training programs supporting FWA prevention, detection, and response. •Direct and oversee investigations into allegations of non-compliance, ethical violations, or fraudulent behavior involving employees, delegated entities, providers, or vendors. •Partner with Legal, Compliance, and Human Resources on sensitive internal investigations to ensure confidentiality, integrity, and fairness. •Ensure timely and accurate reporting of SIU/FWA activity to external agencies to meet regulatory requirements. Qualifications: •Master's Degree in Public Policy or Related Field •Prior leadership of a Special Investigations Unit (SIU) or equivalent function in a health plan, government agency, or large healthcare system. •Certified Coder, RN, MD, PharmaD, or equivalent •The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. •L.A. Care Offers a Wide Range Of Benefits Including Paid Time Off (PTO) Interested candidates, please apply directly through the job posting on company's career page or try via AI auto apply on this platform. Don't miss this opportunity to join a forward-thinking team!