Detroit Wayne Mental Health Authority
Special Investigations Unit Administrator
Detroit Wayne Mental Health Authority, Detroit, Michigan, United States, 48228
SPECIAL INVESTIGATIONS UNIT ADMINISTRATOR
The Compliance Special Investigations Unit (SIU) Administrator provides administrative, operational, and regulatory support to DWIHN’s SIU, which is responsible for identifying, investigating, and reporting potential Fraud, Waste, and Abuse (FWA) involving Medicaid-funded behavioral health services.
This position plays a critical role in supporting DWIHN’s compliance with federal and state Medicaid requirements, including PIHP contractual obligations with the Michigan Department of Health and Human Services (MDHHS), Centers for Medicare & Medicaid Services (CMS), and oversight agencies. The SIU Administrator ensures investigations are properly tracked, documented, reported, and audit-ready, while maintaining strict confidentiality and data integrity.
PRINCIPAL DUTIES AND RESPONSIBILITIES
Maintain SIU case files from intake through closure, ensuring documentation is complete, accurate, and compliant with DWIHN policies and procedures.
Track investigation milestones, statutory and contractual timelines, and case dispositions using DWIHN systems, including CATS, CareConnect360, MHWIN, CHAMPS-related documentation, and internal SIU trackers.
Monitor intake sources including internal referrals, anonymous reports, provider self-disclosures, recipient complaints, and external agency referrals.
Ensure proper version control, labeling, and storage of investigation materials in accordance with DWIHN records-retention requirements.
Support SIU compliance with applicable regulations, including but not limited to:
42 CFR §§ 438.608 (Program Integrity), 438.610 (Prohibited Affiliations), and 455.2 (Fraud, Waste, and Abuse definitions).
Assist with preparation and tracking of referrals, notifications, and disclosures to MDHHS, OIG, CMS, and law enforcement, as directed by Compliance leadership.
Ensure all SIU activities align with DWIHN’s PIHP contract, Compliance Plan, and Program Integrity policies.
Prepare investigation files for internal audits, HSAG reviews, MDHHS site visits, and OIG requests.
Maintain SIU logs and dashboards tracking key metrics such as:
Case volume and status
Intake sources
Days to closure
Referral outcomes
Recoupment amounts and corrective actions
Compile data for monthly, quarterly, and annual Compliance Committee, Risk Management Committee, and Board reporting.
Assist in identifying trends, repeat issues, and emerging risks to support DWIHN’s enterprise risk assessments and corrective action planning.
Schedule and coordinate interviews, case review meetings, multidisciplinary work groups, and leadership briefings.
OTHER RESPONSIBILITIES
Draft and format correspondence, case summaries, referral documentation, and internal memoranda related to SIU activities.
Provide onboarding and administrative support to compliance specialist/investigators, including access coordination, training tracking, and workflow support.
Serve as a liaison between SIU and internal departments including Claims, Provider Network Management, Finance, Legal, HR, Recipient Rights, and Quality.
Handle highly sensitive investigative, personnel, provider, and member information with discretion and professionalism.
Ensure compliance with HIPAA, 42 CFR Part 2, and DWIHN privacy and security policies.
Maintain strict confidentiality of SIU investigations and related materials.
Performs related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)
Working knowledge of Medicaid FWA concepts and investigative workflows.
Familiarity with Michigan Medicaid, PIHP contractual requirements, and MDHHS oversight expectations.
Strong organizational, documentation, and record management skills.
Demonstrated ability to manage multiple cases, deadlines, and competing priorities.
High attention to detail and ability to maintain audit-ready files.
Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and electronic case-management or compliance systems.
Strong written and verbal communication skills.
REQUIRED EDUCATION
Bachelor’s degree in Criminal Justice, Public Administration, Healthcare Administration, Business Administration, or a related field (or equivalent combination of education and experience).
Minimum of 3–5 years of experience in healthcare administration, compliance, investigations, Medicaid programs, or government-regulated environments.
Experience working with Medicaid managed care organizations, PIHPs, behavioral health systems, or public-sector healthcare preferred.
REQUIRED EXPERIENCE Prior experience supporting a Special Investigations Unit, Program Integrity, Compliance, or OIG-facing function.
Familiarity with
Claims review and recoupment processes
Workforce Background Check requirements
Provider enrollment and exclusion screening
REQUIRED LICENSE(S) A valid State of Michigan Driver’s License with a safe and acceptable driving record.
Certification or coursework in compliance or investigations (e.g., CHC, CHPC, CHRC, CFE) preferred.
WORKING CONDITIONS
Office or hybrid work environment.
Position requires handling of sensitive, confidential, and potentially legally privileged information.
May require flexibility to meet regulatory deadlines or audit demands.
This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.
Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer
#J-18808-Ljbffr
The Compliance Special Investigations Unit (SIU) Administrator provides administrative, operational, and regulatory support to DWIHN’s SIU, which is responsible for identifying, investigating, and reporting potential Fraud, Waste, and Abuse (FWA) involving Medicaid-funded behavioral health services.
This position plays a critical role in supporting DWIHN’s compliance with federal and state Medicaid requirements, including PIHP contractual obligations with the Michigan Department of Health and Human Services (MDHHS), Centers for Medicare & Medicaid Services (CMS), and oversight agencies. The SIU Administrator ensures investigations are properly tracked, documented, reported, and audit-ready, while maintaining strict confidentiality and data integrity.
PRINCIPAL DUTIES AND RESPONSIBILITIES
Maintain SIU case files from intake through closure, ensuring documentation is complete, accurate, and compliant with DWIHN policies and procedures.
Track investigation milestones, statutory and contractual timelines, and case dispositions using DWIHN systems, including CATS, CareConnect360, MHWIN, CHAMPS-related documentation, and internal SIU trackers.
Monitor intake sources including internal referrals, anonymous reports, provider self-disclosures, recipient complaints, and external agency referrals.
Ensure proper version control, labeling, and storage of investigation materials in accordance with DWIHN records-retention requirements.
Support SIU compliance with applicable regulations, including but not limited to:
42 CFR §§ 438.608 (Program Integrity), 438.610 (Prohibited Affiliations), and 455.2 (Fraud, Waste, and Abuse definitions).
Assist with preparation and tracking of referrals, notifications, and disclosures to MDHHS, OIG, CMS, and law enforcement, as directed by Compliance leadership.
Ensure all SIU activities align with DWIHN’s PIHP contract, Compliance Plan, and Program Integrity policies.
Prepare investigation files for internal audits, HSAG reviews, MDHHS site visits, and OIG requests.
Maintain SIU logs and dashboards tracking key metrics such as:
Case volume and status
Intake sources
Days to closure
Referral outcomes
Recoupment amounts and corrective actions
Compile data for monthly, quarterly, and annual Compliance Committee, Risk Management Committee, and Board reporting.
Assist in identifying trends, repeat issues, and emerging risks to support DWIHN’s enterprise risk assessments and corrective action planning.
Schedule and coordinate interviews, case review meetings, multidisciplinary work groups, and leadership briefings.
OTHER RESPONSIBILITIES
Draft and format correspondence, case summaries, referral documentation, and internal memoranda related to SIU activities.
Provide onboarding and administrative support to compliance specialist/investigators, including access coordination, training tracking, and workflow support.
Serve as a liaison between SIU and internal departments including Claims, Provider Network Management, Finance, Legal, HR, Recipient Rights, and Quality.
Handle highly sensitive investigative, personnel, provider, and member information with discretion and professionalism.
Ensure compliance with HIPAA, 42 CFR Part 2, and DWIHN privacy and security policies.
Maintain strict confidentiality of SIU investigations and related materials.
Performs related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)
Working knowledge of Medicaid FWA concepts and investigative workflows.
Familiarity with Michigan Medicaid, PIHP contractual requirements, and MDHHS oversight expectations.
Strong organizational, documentation, and record management skills.
Demonstrated ability to manage multiple cases, deadlines, and competing priorities.
High attention to detail and ability to maintain audit-ready files.
Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint) and electronic case-management or compliance systems.
Strong written and verbal communication skills.
REQUIRED EDUCATION
Bachelor’s degree in Criminal Justice, Public Administration, Healthcare Administration, Business Administration, or a related field (or equivalent combination of education and experience).
Minimum of 3–5 years of experience in healthcare administration, compliance, investigations, Medicaid programs, or government-regulated environments.
Experience working with Medicaid managed care organizations, PIHPs, behavioral health systems, or public-sector healthcare preferred.
REQUIRED EXPERIENCE Prior experience supporting a Special Investigations Unit, Program Integrity, Compliance, or OIG-facing function.
Familiarity with
Claims review and recoupment processes
Workforce Background Check requirements
Provider enrollment and exclusion screening
REQUIRED LICENSE(S) A valid State of Michigan Driver’s License with a safe and acceptable driving record.
Certification or coursework in compliance or investigations (e.g., CHC, CHPC, CHRC, CFE) preferred.
WORKING CONDITIONS
Office or hybrid work environment.
Position requires handling of sensitive, confidential, and potentially legally privileged information.
May require flexibility to meet regulatory deadlines or audit demands.
This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.
Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer
#J-18808-Ljbffr