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  • Manager, Compliance Investigations - Remote

    Option Care Health (Itasca, IL)



    Apply Now

    Extraordinary Careers. Endless Possibilities.

     

    With the nation’s largest home infusion provider, there is no limit to the growth of your career.

     

    Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members.

     

    Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you’re empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare.

    Job Description Summary:

    The Manager, Compliance Operations & Investigations supports Option Care Health’s compliance investigation

     

    program by managing investigations from intake through resolution, including allegations received through

     

    established reporting channels. The role conducts root cause analyses, helps implement and track corrective

     

    actions, identifies trends and systemic issues, and provides guidance and reporting to stakeholders. The

     

    Manager collaborates with cross-functional partners to route matters appropriately, resolve issues efficiently,

     

    mitigate compliance risk, and supports the maintenance of investigation, corrective action, and related

     

    compliance polies and procedures in alignment with applicable laws and regulations.

     

    **Job Description:** ​

     

    Conduct investigations into fraud, waste, abuse, and other compliance concerns, ensuring thorough, objective

     

    analysis and documentation.

     

    Support management of the company’s confidential Ethics & Compliance Hotline including intake, case

     

    management workflow, reporting, analytics, and vendor relationships.

     

    Maintain accurate case records in the Compliance case management system.

     

    Develop, implement, and maintain investigation strategies, policies and processes to identify and address

     

    potential violations of laws, regulations, and internal policies.

     

    Collaborate with cross-functional partners to assess, triage, and route investigative matters for appropriate

     

    resolution and risk mitigation. Consult with Legal on compliance-related legal issues and timely communicate

     

    relevant statutory, regulatory or policy changes to business unit leadership.

     

    Conduct root cause analysis and implement corrective actions. Monitor and track remediation completion.

     

    Prepare and present investigation reports to leadership and regulatory authorities, as necessary.

     

    Provide guidance on compliance policies, procedures, and best practices and foster a culture of ethical conduct and non-retaliation.

     

    Maintain current knowledge of relevant healthcare laws and regulations (e.g., HIPAA, Stark Law, Anti-Kickback

     

    Statute, and False Claims Act). Help ensure investigative practices remain current and compliant.

     

    Support Compliance activities related to conflict-of-interest disclosure review and response.

     

    Ensure confidentiality of sensitive business and patient information. Maintain records consistent with Option

     

    Care Health policy and Compliance Department processes.

     

    Support compliance integration initiatives with new business models.

    Supervisory Responsibilities

    Does this position have supervisory responsibilities?

     

    (i.e. hiring, recommending/approving promotions and

     

    pay increases, scheduling, performance reviews,

     

    discipline, etc.)

     

    No

     

    Basic Education and/or Experience Requirements

     

    Bachelor’s degree or Associate degree, preferred in healthcare, business, legal, justice , or related field.

     

    Minimum 4-6 years of progressive experience in investigations, healthcare compliance, or risk management,

     

    including at least 2-4 years in a role overseeing or conducting investigations.

    Basic Qualifications

    Strong investigative skills and experience, including interviewing, evidence analysis, attention to detail, and

     

    good judgment. Ability to conduct thorough, objective and complex investigations, analyze complex data sets,

     

    and draw actionable conclusions.

     

    Knowledge of healthcare laws and regulations, including billing and coding, privacy and security, and fraud,

     

    waste and abuse (e.g., HIPAA, Anti-Kickback, Stark, Medicare and Medicaid reimbursement). Experience

     

    assessing compliance with applicable laws, regulations, standards, and internal policies.

     

    Experience interacting with senior management, legal counsel, federal and state regulators, and law

     

    enforcement.

     

    Excellent communication and interpersonal skills, with the ability to build relationships, influence stakeholders,

     

    and clearly communicate investigative findings.

     

    Experience identifying operational issues and recommending effective solutions.

     

    Experience managing multiple investigations simultaneously, prioritizing work effectively, and providing

     

    regular status updates to leadership.

     

    Strong analytical, problem-solving, and critical-thinking skills.

     

    Self-motivated, accountable for personal growth, and supportive of others’ development, while fostering an

     

    inclusive team environment and engaging in continuing education opportunities and connection.

     

    Ability to handle sensitive and confidential information with professionalism.

     

    Intermediate level skill in Microsoft Excel, Microsoft Word and Microsoft PowerPoint

     

    Physical Demand Requirements

     

    Ability to sit and work on a computer for extended periods of time.

     

    Travel Requirements: (if required)

     

    Willing to travel up to 25% of the time for business purposes (within state and out of state).

     

    Preferred Qualifications & Interests (PQIs)

     

    Certified in investigation tactics, interviewing, fraud examination, and/or compliance (e.g., CFE, AHFI, CHC,

    CPCO)

    Advanced degree (e.g., JD, MBA, MPH) or clinical certification

     

    At least 2 years of direct experience in a compliance role for home infusion services, pharmacy, nursing, or

     

    large payor organization..

     

    At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care regulatory

     

    requirements.

     

    Experience using common third-party software solutions for Compliance and Privacy program management of

     

    incidents, investigations, monitoring and exclusion screening (such as Navex, internal case management

     

    systems, etc.)

    Due to state pay transparency laws, the full range for the position is below:

    Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.

     

    Pay Range is $112,439.64-$187,406.90

    Benefits:

    -Medical, Dental, & Vision Insurance

     

    -Paid Time off

     

    -Bonding Time Off

     

    -401K Retirement Savings Plan with Company Match

     

    -HSA Company Match

     

    -Flexible Spending Accounts

     

    -Tuition Reimbursement

     

    -myFlexPay

     

    -Family Support

     

    -Mental Health Services

     

    -Company Paid Life Insurance

     

    -Award/Recognition Programs

     

    _Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information._

     

    ​

     

    For over 40 years, Option Care Health has provided adult and pediatric patients with an alternative to hospital infusion therapy. With more than 2,900 clinical experts, Option Care Health is able to provide high-quality infusion services for nearly all patients with acute and chronic conditions across the United States, resulting in high quality outcomes at a significantly reduced cost. Option Care Health has more than 70 infusion pharmacies and 100 alternate treatment sites. We are guided by our purpose to provide extraordinary care that changes lives through a comprehensive approach to care along every step of the infusion therapy process including: intake coordination, insurance authorization, resources for financial assistance, education and customized treatments.

     


    Apply Now



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