We are seeking a Special Investigative Unit (SIU) coordinator to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
About the Role:
The Special Investigative Unit (SIU) Coordinator plays a critical role in overseeing and managing investigations related to fraud, abuse, and other compliance issues within the healthcare and social assistance sector. This position ensures that all investigative activities are conducted thoroughly, ethically, and in accordance with regulatory standards and organizational policies. The coordinator acts as a liaison between internal departments, external agencies, and legal entities to facilitate information sharing and resolution of cases. By leading a team of investigators, the coordinator ensures timely and accurate documentation, analysis, and reporting of findings to support corrective actions and risk mitigation. Ultimately, this role contributes to safeguarding organizational integrity, protecting members rights, and maintaining compliance with healthcare laws and regulations.
Minimum Qualifications:
- Bachelor’s degree in Criminal Justice, Healthcare Administration, Social Work, or a related field.
- Minimum of 3 years of experience in healthcare investigations, compliance, or a related area.
- Strong knowledge of healthcare laws, regulations, and compliance standards including HIPAA and Medicare/Medicaid rules.
- Proven experience in managing investigative teams or projects.
Preferred Qualifications:
- Master’s degree in Criminal Justice, Healthcare Administration, Social Work, or a related field.
- Certification in Fraud Examination (CFE) or Healthcare Compliance (CHC) is highly desirable.
- Experience working within a Special Investigative Unit or similar healthcare fraud prevention team.
- Familiarity with data analytics tools and investigative software.
- Advanced degree in a relevant field such as Public Health, Law, or Business Administration.
- Demonstrated ability to work collaboratively with law enforcement and regulatory agencies.
Responsibilities:
- Manage and coordinate investigations of suspected fraud, waste, and abuse within healthcare programs, ensuring compliance with legal and regulatory requirements.
- Develop and implement investigative plans while maintaining confidentiality and security of sensitive information.
- Supervise, train, and support investigative staff, overseeing performance, case management, and professional development.
- Collaborate with internal departments and external agencies, including compliance, legal, clinical teams, law enforcement, and regulators.
- Prepare detailed reports, track investigative trends, and present findings to leadership, recommending policy or procedural changes to strengthen compliance and risk management.
Skills Required
- Bachelor's degree in Criminal Justice, Healthcare Administration, Social Work, or related field
- Minimum of 3 years of experience in healthcare investigations, compliance, or related area
- Strong knowledge of healthcare laws, regulations, and compliance standards including HIPAA and Medicare/Medicaid rules
- Proven experience in managing investigative teams or projects
- Master's degree in Criminal Justice, Healthcare Administration, Social Work, or related field
- Certification in Fraud Examination (CFE) or Healthcare Compliance (CHC)
- Experience working within a Special Investigative Unit or similar healthcare fraud prevention team
- Familiarity with data analytics tools and investigative software
- Advanced degree in Public Health, Law, or Business Administration
- Demonstrated ability to work collaboratively with law enforcement and regulatory agencies
What We Do
Independent Living Systems, LLC, offers a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid and Dual-Eligible Market. Independent Living Systems has been an industry leader in managing home and community-based programs for over 16 years. Leveraging ILS’ award winning technology platform, ILS provides assistance beyond the clinical realm at every stage of care from hospitalization to the treatment of chronic illnesses to personalized care management including nutritional support. As one of the country’s leading providers of Nutritional Support Services and medically tailored meals, ILS provides nutrition counseling and home delivered meals for individuals transitioning from acute settings to the home as well as for those combatting the effects of one or more chronic diseases. In partnership with health plans, providers, hospitals, and pharmaceutical and medical device companies, ILS provides solutions aimed at improving health outcomes while rebalancing costs. ILS’ suite of products and services include: MLTSS - Managed Long-Term Services Supports Suite of solutions including assessments, care management, and coordination of home and community-based services, care planning, and back-office support CCM - Comprehensive Care Management A streamlined solution for ongoing care management and care optimization targeted towards special needs populations and special needs plans Meals and Nutrition One of the nation’s largest nutritional providers delivering consistent, high-quality therapeutic meals to elderly and at-risk populations TPA – Third Party Administration A fully integrated business and technology offering to support all administrative and financial reporting requirements of health plans and risk bearing entities MSO – Management Services Organization Population and provider-based interventions to address utilization and monitor unit costs of services For more information please contact us via email at [email protected].
