McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $6 billion (budget FY21), fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 15 hospitals in Michigan and Ohio, ambulatory surgery centers, imaging centers, a 490-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering approximately 640,000 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 51 National Cancer Institute-designated comprehensive cancer centers in the U.S. As part of its Graduate Medical Education (GME) program, McLaren maintains academic affiliations with medical schools at Wayne State University, Michigan State University and Central Medical University. McLaren’s six (6) GME campuses offer 27 residencies and eight (8) fellowship programs that train over 650 future physicians annually. All GME programs at McLaren are overseen and managed centrally by the Department of Academic Affairs.

Job description

We are looking for a Special Investigative Unit Auditor to join us in leading our organization forward.

McLaren Integrated HMO Group (MIG), a division of McLaren Health Care Corporation, is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.

McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org

MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.Learn more about MDwise, Inc. at https://www.mdwise.org/

Position Summary:

Responsible for conducting comprehensive investigations of reported, alleged or suspected fraud involving the full range of products for assigned Plan. Ensures compliance with all requirements related to Special Investigation Units and fraud, waste and abuse investigations.

This position is fully remote.

Equal Opportunity Employer of Minorities/Females/Disabled/Veterans

Qualifications:

Required:

Associate Degree in business, health care or related field.
Three (3) years’ experience in progressively more responsible positions using analytical skills with at least two (2) years’ experience in compliance or related function.

Preferred:

Bachelor’s Degree in business, health care or related field.
Certification such as RHIT, RHIA, AHFI, CFE, CPMA or CPC.
Two (2) years’ experience and knowledge of HMO, or PPO (e.g. accounting/finance, reinsurance, regulatory compliance, claims processing, membership/eligibility, and actuarial precepts).
Course work or work experience in statistics.

Additional Information