Investigator

• Independently plan, conduct, and manage prompt, thorough onsite and desk-top investigations of health care claims.
• Thoroughly document investigative findings and actions to create comprehensive case files in accordance with established policies and procedures.
• Proactively utilize available analytic resources to identify patterns of potential Fraud, Waste and Abuse, initiating audits when necessary.
• Conduct fact-finding interviews with internal staff, external providers, patients and other relevant parties regarding medical and behavioral health services initiating investigations when necessary.
• Utilize available Open Source Intelligence (OSINT) tools to verify provider licenses, research criminal history, disciplinary actions, financial assets and liabilities.
• Attend and participate in regional FWA Task Force and other state or federal meetings.
• Establish and maintain a comprehensive knowledge and understanding of current state and federal reporting requirements ensuring FWA reporting is received, summarized, catalogued, and disseminated to the appropriate agencies.
• Ensure regulatory reporting is developed, accurate, and submitted timely.
• Serve as an internal Subject Matter Expert (SME) on matters related to auditing and FWA.
• Develop and conduct internal FWA related training.
• Collaborate with government agencies during audits, investigations and Requests for Information (RFI).
• Present and discuss case findings and recommendations in case review meetings with department and company management.
• Participate in the development and presentation of FWA reporting for the Corporate Compliance Committee and the Audit and Compliance Committee of the Board.
• Coordinate and manage the production of investigative materials in support of settlement negotiations.

Senior Investigator managing healthcare fraud investigations at PacificSource.

Senior Investigator

Senior Investigator managing healthcare fraud investigations and compliance at PacificSource. Leading audit activities across dedicated teams and ensuring regulatory adherence.

• Assist the Principal Investigator (PI) in overseeing and managing clinical trials conducted at the research site, ensuring adherence to the study protocol, Good Clinical Practice (GCP), ICH guidelines, and all applicable regulatory requirements.
• Provide medical oversight and ensure the safety and well-being of study participants throughout the trial, under the supervision of the PI.
• Perform delegated study-related duties as assigned by the PI, which may include comprehensive patient assessments, physical exams, medical histories, and eligibility screenings.
• Review and interpret eligibility, laboratory results, ECGs, and other diagnostic tests as required by the protocol and under PI supervision.
• Assist the PI in making medical decisions regarding participant care, adverse events, and protocol deviations.
• Ensure accurate, complete, and timely collection and documentation of all study data.
• Communicate effectively with the PI, study team, and, as delegated, with sponsors, Contract Research Organizations (CROs), Institutional Review Boards (IRBs), and regulatory authorities.
• Assist with investigational product accountability, storage, and administration according to protocol.
• Participate in site initiation visits, monitoring visits, audits, and inspections as required.
• Maintain continuous medical education and stay current with advancements in clinical research and relevant therapeutic areas.

Nurse Practitioner or Physician Assistant leading clinical trials for community-based healthcare provider

Sub Investigator, NP/PA-C

Nurse Practitioner or Physician Assistant leading clinical trials at Springfield's community site network. Supporting research with experience in sponsor initiated trials as Principal or Sub-Investigator.

Investigator jobs in Montana

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Senior Investigator

Sub Investigator, NP/PA-C