Healthcare Investigations Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the intake, triage, and investigation of compliance hotline reports.

• Assign cases to team members based on their expertise and capacity, providing guidance on investigation procedures and standards.

• Perform comprehensive investigations by gathering facts, interpreting policies, analyzing data, and addressing sensitive issues with discretion.

• Identify when escalation is required.

• Manage response and corrective-action workflows, define findings, drive remediation efforts, confirm closure, and document investigative steps until resolution.

• Conduct Policy Gap analyses.

• Investigate potential HIPAA and Security Policy violations in collaboration with the IT Security team.

• Execute monthly and new-vendor exclusion screenings against federal and state exclusion lists.

• Coordinate self-disclosures and escalations with Legal and compliance leadership.

• Prepare quarterly reports on investigations and disclosure programs for senior leadership and the Compliance Committee/Board.

• Identify trends and assist in risk-assessment discussions.

• Oversee compliance case management and exclusion screening platforms, ensuring proper configuration, user access, and data integrity.

• Manage and mentor 2–3 direct reports.

• Enhance team capacity as hotline volume increases.

• Perform additional duties as assigned.

⛳️ Requirements

• Proven experience in running a healthcare investigations or hotline function full-time, preferably in a compliance or regulatory environment.

• Direct experience in investigating HIPAA/Security Policy violations, ideally in partnership with an IT Security team.

• Practical experience in administering a compliance case management or hotline platform.

• Proficient in preparing and presenting investigation trends and disclosure program data to senior leadership.

• Strong skills in root-cause analysis and maintaining audit-ready documentation.

• Excellent capabilities in Policy gap analysis and collaborating with leaders to implement necessary changes.

• Familiarity with OIG guidance, particularly Elements 4 and 7.

• Comfortable managing a small team while remaining hands-on with casework, especially during the initial build phase.

• CHC (Certified in Healthcare Compliance) certification is preferred.

• High integrity and a collaborative mindset with low ego across Legal, Compliance, IT Security, and Operations.

🏝️ Benefits

• Medical, Dental, and Vision plans.

• Flexible Spending/Health Savings Accounts.

• Flexible PTO.

• 401(k) with Company Match.

• Life Insurance.

• Pet insurance.

• Flat organizational structure.

• A work culture focused on Autonomy, Competence, and Belonging.