Mar 15, 2019
The Senior Investigator is responsible to directly conduct investigations of a critical or high-risk nature. Investigations may involve multiple disciplines, including Compliance, Privacy, Human Resources, Fraud and Abuse or others, with the requirement to manage and prioritize investigative workload effectively and efficiently to achieve accurate and time sensitive results. Coordinates with other investigatory subject matter experts. Ensures that all assigned cases follow standard protocols, and uses the appropriate SH tools and templates when carrying out all aspects of investigation work. Supports the department in carrying out assigned program initiatives and related program goals and objectives.
Bachelor's degree from an accredited college or university in business, criminal justice, political science, human resources or similarly related field required or equivalent education/experience.
**Licensures and Certifications**
Law enforcement, private investigator related or similar training preferred.
• Significant experience in investigating major criminal, compliance, privacy, fraud waste or abuse, or other serious misconduct in 5 or more years of increasingly responsible roles required.
• Healthcare investigative experience of at least 2 of the 5 years strongly preferred
• Background as a Government or Corporate Investigator, such as for a state or federal agency, or corporation strongly preferred.
**Skills and Knowledge**
• Knowledge of applicable rules, regulations, requirements and standards, including those of Centers for Medicare and Medicaid (CMS), the Office of the Inspector General (HRS/OIG) and other related divisions of the Department of Health and Human Services (HHS), federal and state anti-kickback and physician self-referral laws (e.g. Stark and PORA), provider/practitioner licensure and scope of practice requirements, privacy and consent laws.
• Working knowledge of healthcare compliance, privacy, billing compliance and/or employment law.
• Excellent written and verbal communication skills.
• Demonstrated interview and interrogation/investigation experience.
• Demonstrated ability to document investigative results and corrective action plans that are easily understandable to those key stakeholders with a “need-to-know”.
• Must be highly organized and detail-oriented.
• Demonstrated ability to set priorities and respond to changing demands from multiple sources in a fast-paced environment.
• Ability to follow through, meet deadlines, anticipate requirements, and build relationships with minimal oversight.
• Strong analytical, problem-solving and time management skills.
• Ability to exercise independent judgment and employ strong reasoning skills.
• Must be able to work collaboratively in a team environment with minimal supervision.
• Database management experience and comfort level w/ internal systems or demonstrated ability to learn new systems.
• Demonstrated ability to work with all levels of individuals, from general staff and middle -management to senior C-Suite leaders and medical staff.
• PC skills including MS Word, Excel, Outlook and PowerPoint.
• Must be able to prioritize assignments and tasks to complete investigations within specified time parameters.
• Must present as approachable, open, professional and positive.
• Must be willing to travel on short notice and during non-standard working hours.
**Organization:** Sutter Health System Office
**Employee Status:** Regular
**Position Status:** Exempt
**Job Shift:** Day
**Shift Hours:** 8 Hour Shift
**Days of the Week Scheduled:** Monday-Friday
**Weekend Requirements:** Other
**Schedule:** Full Time
**Hrs Per 2wk Pay Period:** 80
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.