Remote High-Risk Provider Oversight Lead

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

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