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Explore a World of Opportunity with the State of Georgia! We are the force that drives Georgia! Georgia State Government is a large enterprise, composed of various agencies and entities with a common goal to improve the lives of Georgia's more than 10 million citizens! Join Team Georgia and impact lives everyday while receiving a robust benefits package designed for every stage of your career! Job Title: Investigations Manager Agency: Department of Community Health Job Requisition ID: JR0000004059 Shift: Not Applicable (United States of America) Compensation Details: $56,310.72 - $80,000 Job Description: The position provides critical support functions within the Program Integrity Unit and the Office of Inspector General, which helps safeguard the agency from fraud, waste, and abuse. The selected candidate will be responsible for managing two (2) direct reports charged with investigating providers for fraud, waste, and abuse in the Fee-for-Service Medicaid program. The Investigations Manager provides guidance and feedback to the team to ensure adherence to performance metrics and timeliness of business processes for the Program Integrity Unit. The Investigations Manager analyzes claims data to identify aberrant billing trends for providers to facilitate utilization review. The Investigations Manager conducts and leads provider on sites throughout Georgia to request medical records, conduct interviews, and tour facilities to ensure appropriate medical equipment is onsite to support services billed to Medicaid. The Investigations Manager reviews documentation for Participant and Consumer Directed Care services to investigate allegations of false claims billed to Medicaid. The Investigations Manager reviews referrals, hotline complaints, and participates in Surveillance Utilization Review meetings to identify providers for utilization review Minimum Qualifications: Bachelor's degree in operations management, business administration, or a related field which includes three (3) years in a managerial or supervisory role; or seven (7) years of related professional experience which includes three (3) years in a managerial or supervisory role; or three (3) years of experience required at the lower level Mgr, Business Ops (GSM010) or position equivalent.--Note: An equivalent combination of knowledge, education, job or intern experience, training, or certifications that provides the necessary knowledge and skills to successfully perform the job at the level listed may be substituted year-over-year. Equal Employment Opportunity Employer The State of Georgia does not discriminate based on race, color, national origin, sex, religion, age, disability, or other protected categories in employment or the provision of services. Qualified applicants may request reasonable accommodation when needed during the application and/or screening process by contacting the appropriate agency Human Resources department. Georgia State Government is a large enterprise, composed of various entities with a common goal to improve the lives of Georgia's 10 million citizens. With nearly 62,000 employees, we are one of the single largest employer in the state. Public service opportunities stretch across the state as employees live and work in all 159 counties. From traditional fields such as accounting, nursing, and engineering to unique fields like forestry and natural resources management, Georgia state government provides a world of opportunity. Details Details Details
Georgia
419 2 MLK JR Drive SE, United States of America
Investigations Manager.
$56.3K–80K/YR
more at Georgia.
31 Oct, 2026
Georgia
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