High-Risk Provider Management Supervisor (WMS2/DAIO)

State-of-Washingto; Olympia (WA); Remote; USD 120,000 - 150,000; Full time

Benefits offered by this job

Remote work

Medical, dental, vision insurance

Paid vacation and holidays

Retirement options

Training and professional development

Job summary

The Washington State Health Care Authority seeks a High-Risk Provider Management Supervisor to lead a new team overseeing high- and moderate-risk Medicaid providers. This full-time remote role requires setting policies guiding risk determinations and coordinating with CMS and law enforcement to ensure accountability.

You will supervise field visits, manage reminders and deadlines, and develop legally defensible decisions for provider actions, with a focus on program integrity and inter-agency

Qualifications

• Master-level knowledge of health care compliance frameworks, 42 CFR Part 455.
• Ability to translate statutes into actionable SOPs for operations.
• Experience drafting enrollment denials or terminations with legal defensibility.

Responsibilities

• Supervise a team handling enhanced oversight and site visits for high- and moderate-risk providers.
• Authorize unannounced site visits and manage related budgets and SOPs.
• Oversee LEIE and SAM screening and analyze billing patterns and provider histories.
• Coordinate with CMS, law enforcement, and other oversight bodies on risk issues.
• Develop denial/termination letters and provider enrollment policy recommendations.

Skills

Medicaid regulation

Regulatory compliance

Data & analytics

Strategic leadership

Education

Bachelor's degree in a relevant field

Law degree preferred

Tools

LEIE checks

SAM checks

Job description

High-Risk Provider Management Supervisor

This is a full-time permanent, remote position. Employees may occasionally be asked to attend an in-person meeting or event based on business needs.

All HCA employees are required to be Washington state residents upon their first day of employment.

The Opportunity

Protect Washington's Medicaid program and the people it serves. The Division of Audit, Integrity, and Oversight (DAIO) is seeking a High-Risk Provider Management Supervisor to lead HCA's new High-Risk Provider Management Team. This team is HCA's primary authority for overseeing high- and moderate-risk Medicaid providers, administering enhanced oversight mechanisms, and developing provider termination and disenrollment recommendations. You will set the policies and procedures that guide consistent risk determinations and enforcement actions, and coordinate with managed care organizations, sister agencies, and law enforcement to bring accountability and transparency to how Medicaid funds are spent.

Key Responsibilities Include

• Supervise a team of professional staff responsible for enhanced oversight, monitoring, and site visits of high- and moderate-risk Medicaid providers.
• Assign and elevate provider risk levels, initiate required fingerprint-based criminal background checks, and enforce regulatory deadlines.
• Authorize and plan unannounced site visits, develop field task orders and standard operating procedures, and manage the site visit team's budget of approximately $200,000 a year.
• Oversee daily screening of providers against the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM), along with reviews of billing patterns, geographic data, and corporate histories.
• Identify red flags, elevate concerns to leadership or HCA's Special Investigations Unit, and coordinate with CMS, law enforcement, the Medicaid Fraud and Abuse Division, and other oversight entities.
• Develop legally defensible denial and termination letters, evidence packets, and recommendations that support risk decisions during provider appeal hearings.
• Partner with Provider Enrollment on revalidation schedules and on provider termination and enrollment policy recommendations.
• Develop policies and procedures for temporary provider moratoria under 42 CFR 455.470.
• Analyze legislation affecting program integrity, advise executive leadership, and contribute to WAC development and agency-wide process improvements.

Why You’ll Love This Role

• You’ll be on the front line of protecting Medicaid clients and public dollars, influencing the integrity of billions of dollars in services.
• You’ll help build a new team from the ground up, setting the practices and standards it will rely on for years to come.
• You’ll work alongside federal partners, law enforcement, and sister agencies on complex cases where your judgment makes a real difference.
• You’ll lead a dedicated team while working remotely, with alternative work schedules available based on business needs.

What You Bring

You are a steady, detail-oriented leader who meets your commitments, works independently, and stays focused under pressure, making sound decisions even when there is no precedent to follow. You deal with others in a straightforward and honest way, maintain confidentiality, and support agency values. You bring strong interpersonal skills, respond to questions and concerns with professionalism and care, and hold yourself and your team to a high standard of accuracy and continuous quality improvement. You coach your staff in ways that build a strong culture of compliance.

Required Qualifications

Experience may have been gained through paid or unpaid activities. Please ensure any relevant experience defined below is outlined in your cover letter, resume, and application.

Regulatory Compliance & Legal Mastery

• Federal & State Medicaid Regulation Expertise: Master-level knowledge of health care compliance frameworks, specifically 42 CFR Part 455 (Program Integrity in Medicaid), including 42 CFR 455.470 regarding provider enrollment moratoria.
• Legislative Analysis & Policy Formulation: Demonstrated ability to dissect complex bills and federal legislation, project their operational impacts, advise executive leadership on strategic trade-offs, and translate statutory mandates into actionable Standard Operating Procedures (SOPs).
• Evidentiary Documentation & Legal Defensibility: Demonstrated expertise in authoring administrative summaries, chronological evidence packets, and formal enrollment denial or termination letters that are technically rigorous and legally defensible during provider appeals and hearings.

Risk Management & Investigative Oversight

• Categorical Risk Assessment & Profiling: Demonstrated advanced capabilities in provider risk stratification (Limited, Moderate, High), identifying behavioral red flags, and utilizing data points (geographical data, billing patterns, corporate histories) to confirm provider profiles.
• Background Screening & Enforcement Workflows: Demonstrated mastery of orchestrating mandatory fingerprint-based criminal background checks (FCBC), managing strict regulatory timelines, and executing enforcement mechanisms for non-compliance.
• Sanction Screening Integration: Proficiency in managing daily high-volume data-matching workflows against federal databases, specifically the HHS/OIG List of Excluded Individuals/Entities (LEIE) and the System for Award Management (SAM).

Field Operations & Resource Management

• Tactical Field Supervision: Demonstrated competency in designing, budgeting, and executing unannounced physical site visits. This includes generating targeted investigator task orders, structural checklists, and maintaining strict behavioral and safety standards for field staff.
• Audit Readiness & Digital Governance: Demonstrated mastery of maintaining meticulous, structured, and auditable digital case files that can withstand scrutiny from federal auditors or law enforcement.

Strategic Collaboration & High-Level Leadership

• Cross-Agency & Law Enforcement Liaison: Proven ability to interface and coordinate joint efforts with heavy-hitting external oversight bodies, including the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit (MFCU), Unified Program Integrity Contractors (UPIC), and Recovery Audit Contractors (RAC).
• Inter-Organizational Streamlining: Demonstrated skills in aligning strategies across Managed Care Organizations (MCOs), sister divisions, and Provider Enrollment units to build complex prioritization schedules (e.g., provider revalidation cycles).
• Coaching & Human Capital Development: Expert mentorship capabilities to upskill section staff, foster a culture of compliance, and lead agency-wide process improvement initiatives alongside senior executives.

Required Competencies

• Equity lens – All HCA employees are required to consider equity in their decisions, processes, and day-to-day work, including how their work may affect the people and communities we serve.
• The ability to take action to learn and grow – You take action to learn and grow by seeking new perspectives, learning from experiences, and using what you’ve learned to continuously improve how you work and serve others.
• The ability to take action to meet the needs of others – You take action to meet the needs of others by listening, understanding different perspectives, and responding with care, respect, and solutions that support the people of the communities we serve.

Preferred Qualifications

• Supervisory experience, including conducting employee performance reviews.Demonstrated ability to problem-solve, prioritize workloads, meet deadlines, and provide independent strategic direction and decision-making.
• A bachelor's or master's degree in business administration, public administration, contracting, business law, commerce, mathematics, statistics, economics, or a closely allied field.
• A law degree from an accredited college or university approved by the Washington State Bar Association. Demonstrated expert-level experience in the administration of Medicaid funds and expenditures, or experience working with Medicaid or the behavioral health industry.
• Ability to clearly communicate complex information, verbally and in writing, to a non-technical audience.

About the Division of Audit, Integrity, and Oversight (DAIO)

The Division of Audit, Integrity, and Oversight (DAIO) is within the Office of the Chief of Staff (COS) of the Health Care Authority and provides support to all HCA divisions at all employee levels. The goal of DAIO is to combat fraud, waste, and abuse in HCA medical and behavioral health programs, ensuring HCA's programs operate at optimal fidelity and protecting state and federal funds.

The Washington State Health Care Authority

Better Health. Better Care. A Healthier Washington. At HCA, we work to ensure people across Washington have the opportunity to be as healthy as possible. As the State’s largest health care purchaser and behavioral health authority, HCA serves nearly 3 million Washington residents through Apple Health (Medicaid), Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs, and behavioral health services. Through this work, HCA purchases and coordinates care coverage, supports behavioral health prevention, treatment, crisis response, and recovery and helps strengthen access to high-quality care across Washington.

More than a benefits package

We want our employees to have the support, flexibility, and benefits they need to do their best work and build a career that works for their life. As a Washington State HCA employee, you’ll have access to a comprehensive benefits package that supports your health, financial well-being, and work-life balance. Our benefits are designed to support you today while helping you plan for the future. Learn more about why HCA by visiting the Voices of HCA and the "Who we are" section of our website.

Your total compensation is more than your paycheck

• Remote work and flexible schedules
• Medical, dental, vision, and basic life insurance
• Paid vacation, sick leave, and 12 paid holidays
• Paid Family and Medical Leave (PFML)
• Retirement options to plan for the future
• Training and professional development opportunities
• Employee wellness programs
• Learn more about Washington State Employee Benefits

Work Location and Schedule

This is a full-time 40-hour-per-week remote position. Our standard business hours are Monday through Friday, 8 a.m. to 5 p.m., with alternative work schedules considered based on business needs and supervisor approval. In this role you will regularly collaborate with colleagues, agency leaders, state and federal partners, and other external partners or customers. Occasional travel may be required for meetings, training, or other business needs. All employees are required to report to our Olympia office on their first and final day of employment.

Our commitment to an inclusive workplace

The Health Care Authority is an equal opportunity employer. We are committed to creating a workplace where employees are respected, included, and supported in bringing their experiences, perspectives, and ideas to work. Our commitment to inclusion is reflected in how we work together and serve the people of Washington. HCA also supports five voluntary employee led Employee Resource Groups (ERGs), which create opportunities for connection, community, learning, and professional growth.

Veterans

We value the experience and skill veterans bring to the workforce and encourage veterans, transitioning service members, and military spouses to apply. Eligible veterans may qualify for veterans’ preference in accordance with Washington State Law. If you are claiming veterans’ preference, you must attach your applicable DD-214 documentation to your application. Please redact your social security number, date of birth, and any other sensitive information before uploading and attaching the document.

The Washington State Health Care Authority (HCA) is an E-Verify employer. All applicants with a legal right to work in the United States are encouraged to apply.

E-Verify® is a registered trademark of the U.S. Department of Homeland Security.