Manager, Special Investigations Unit - Pharmacy Investigations - Remote

Overview

We are seeking a dynamic and experienced leader to spearhead our Special Investigations Unit (SIU), overseeing our enterprise-wide Fraud, Waste, and Abuse (FWA) program. This is a high-impact, strategic role ideal for a people leader with deep expertise in pharmacy investigations and a passion for protecting healthcare systems from abuse.

In Short

• Build and manage a best-in-class FWA program aligned with federal and state regulations.
• Lead complex investigations into potential FWA involving pharmacies, prescribers, and members.
• Develop and enforce SIU/FWA policies and procedures.
• Analyze data to identify emerging fraud trends.
• Prepare and present detailed investigative reports to executive leadership.
• Collaborate with internal teams and external stakeholders.
• Deliver FWA training and education to internal teams.
• Represent Capital Rx in legal proceedings.
• Foster a culture of compliance and continuous improvement.
• Lead and mentor a high-performing investigations team.

Requirements

• Minimum 5 years in health care fraud investigations, preferably pharmacy investigations.
• Proven ability to lead cross-functional teams.
• Deep knowledge of pharmacy investigations and healthcare FWA laws.
• AHFI, CFE, Pharmacy Technician, or HCAFA certifications required.
• Bachelor’s degree in healthcare, Criminal Justice, or related field.
• Exceptional analytical, communication, and interpersonal skills.

Benefits

• Flexible position description to meet organizational goals.