Investigations Lead

Responsibilities

• Leads the investigation functions of the task order, including the review of dispensers, pharmacies, and manufacturers' practices to ensure adherence to Drug Price Negotiation Program requirements.
• Develops all necessary compliance requirements to inform compliance, investigations, reporting and market surveillance activities.
• Manages investigators and develops necessary investigation processes to ensure implementation of timely, thorough, and unbiased investigations.
• Develops an investigation strategy and approach to ensure investigations are completed in accordance with program timelines and quality standards.
• Identify and assess potential risks or violations through data analysis, stakeholder interviews, audits, and tips received through oversight channels.
• Oversee intake, triage, and prioritization of investigative matters aligned with CMS compliance objectives.
• Collaborate with data analysts, auditors, compliance officers, and legal experts to collect and assess evidence.
• Draft detailed investigation plans, memoranda, and final reports with actionable findings and recommendations.
• Coordinate with CMS, OIG, and other federal oversight bodies on escalated matters requiring enforcement or corrective action.
• Maintain a secure, documented chain of evidence throughout each case in compliance with federal guidelines.
• Establish and refine investigation protocols, SOPs, and escalation procedures in coordination with the compliance and auditing teams.
• Mentor junior staff and serve as subject matter expert (SME) in investigative techniques and healthcare program integrity.

Requirements:

• Bachelor's degree in Criminal Justice, Public Administration, Healthcare Compliance, Law, or related field (Master's preferred).
• Minimum of 10 years of experience leading investigations within a federal healthcare, regulatory, or compliance setting.
• Demonstrated knowledge of Medicare Part D, drug pricing, manufacturer rebate structures, or government pricing programs.
• Strong analytical and investigative skills, with experience leading investigations in a regulatory or government setting.
• Knowledge of federal healthcare regulations, especially those related to pharmaceutical pricing and compliance with government programs.
• Exceptional communication and writing skills, with ability to present complex findings to technical and non-technical audiences.
• Strong project management skills with the ability to manage multiple investigations simultaneously.
• Experience using case management systems, e-discovery tools, and data analytics platforms.

EEO Employer:

RELI Groupis an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.

HUBZone:

We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing theSBA HUBZone Map.

The annual salary range for this position is $120,000 to $140,000.Actual compensation will depend on a range of factors, including but not limited to the individual's skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers clickhere