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Medicaid Fraud Inspector Jobs (NOW HIRING)

Jawonio

Assistant Director of Nursing

New City, NY · On-site

$100K - $110K/yr

... inspection, retaining and hiring. Contributes to the performance evaluations of RN, LPN, and CNA ... Must be clear and maintain an acceptable record under the Medicaid Fraud & Abuse clearance process.

Jawonio

Assistant Director of Nursing

New City, NY · On-site

$76K - $101K/yr

... inspection, retaining and hiring. Contributes to the performance evaluations of RN, LPN, and CNA ... Must be clear and maintain an acceptable record under the Medicaid Fraud & Abuse clearance process.

Parkland Health

Three years Medicaid or CHIP Fraud, Waste, and Abuse investigatory experience. * Experience in ... Office of Personnel Management Office of the Inspector General (OPM OIG), State Departments of ...

Alaska Department of Law

Attorney-Advisor

Chicago, IL · On-site

$100 - $125/hr

The OIG for HHS fights fraud, waste and abuse in HHS programs including Medicare, Medicaid, Healthcare Marketplaces, NIH, FDA, CDC and more. HHS OIG is the largest Federal inspector general's office ...

Alaska Department of Law

$100 - $125/hr

The OIG for HHS fights fraud, waste and abuse in HHS programs including Medicare, Medicaid, Healthcare Marketplaces, NIH, FDA, CDC and more. HHS OIG is the largest Federal inspector general's office ...

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Medicaid Fraud Inspector information

What does a Medicaid Fraud Inspector do?

A Medicaid Fraud Inspector investigates allegations of fraud, waste, and abuse within the Medicaid program. Their responsibilities include reviewing claims, gathering evidence, interviewing witnesses, and collaborating with law enforcement agencies to identify and stop fraudulent activities. They help ensure that Medicaid funds are used appropriately and that providers and recipients comply with all relevant laws and regulations. By preventing fraud, they protect both taxpayers and vulnerable populations who rely on Medicaid services.

What are the key skills and qualifications needed to thrive as a Medicaid Fraud Inspector?

To thrive as a Medicaid Fraud Inspector, you need a strong background in criminal justice, finance, or healthcare, often supported by a relevant degree and investigative experience. Familiarity with data analysis software, case management systems, and knowledge of Medicaid regulations and fraud detection techniques is essential. Attention to detail, critical thinking, and strong communication skills help inspectors effectively analyze evidence and coordinate with law enforcement agencies. These skills ensure accurate identification, investigation, and prevention of fraudulent activities to protect public funds and maintain program integrity.

What are some common challenges faced by a Medicaid Fraud Inspector, and how can they be addressed?

Medicaid Fraud Inspectors often encounter challenges such as navigating complex healthcare regulations, analyzing large volumes of data, and dealing with uncooperative individuals during investigations. Staying current with ever-evolving policies and maintaining attention to detail are crucial for success in this role. Collaborating closely with legal teams, healthcare providers, and law enforcement helps address these challenges and ensures thorough investigations. Ongoing professional development and training in investigative techniques can also support inspectors in overcoming these obstacles.

What is the difference between Medicaid Fraud Inspector vs Medicaid Investigator?

AspectMedicaid Fraud InspectorMedicaid Investigator
CredentialsTypically requires certifications like CFE or CPAOften requires similar certifications, sometimes with additional law enforcement credentials
Work EnvironmentGovernment agencies, healthcare compliance departmentsLaw enforcement agencies, government offices
Employer & IndustryState Medicaid agencies, healthcare organizationsState or federal law enforcement, Medicaid fraud units
Search & Comparison IntentHigh overlap in fraud detection and compliance rolesFocuses more on investigation and enforcement actions

Medicaid Fraud Inspectors primarily focus on auditing and detecting fraud within Medicaid programs, often working in compliance roles. Medicaid Investigators tend to conduct in-depth investigations, often with law enforcement authority. Both roles require similar credentials and work within government or healthcare settings, but their core functions differ in scope and enforcement authority.

How hard is it to become a Medicaid Fraud Inspector?

Becoming a Medicaid Fraud Inspector typically requires a background in criminal justice, auditing, or healthcare compliance, along with relevant experience. Many positions require a bachelor's degree and knowledge of Medicaid policies, with some roles benefiting from certifications such as Certified Fraud Examiner (CFE). The process involves applying for government or agency positions, passing background checks, and sometimes completing specialized training.

How to become a Medicaid Fraud Inspector?

To become a Medicaid Fraud Inspector, candidates typically need a bachelor's degree in criminal justice, healthcare administration, or a related field. Relevant experience in auditing, investigations, or healthcare compliance, along with knowledge of Medicaid policies, is important; some roles may require certification such as the Certified Fraud Examiner (CFE). Professional skills in investigation, data analysis, and attention to detail are essential for success in this role.

What qualifications do you need to be a Medicaid Fraud Inspector?

To become a Medicaid Fraud Inspector, candidates typically need a bachelor's degree in criminal justice, healthcare administration, or a related field. Relevant experience in auditing, investigations, or healthcare compliance, along with knowledge of Medicaid policies and regulations, is also important; some roles may require certification such as the Certified Fraud Examiner (CFE).
More about Medicaid Fraud Inspector jobs

What cities are hiring for Medicaid Fraud Inspector jobs?

Cities with the most Medicaid Fraud Inspector job openings:

What states have the most Medicaid Fraud Inspector jobs?

States with the most job openings for Medicaid Fraud Inspector jobs include:

What are popular job titles related to Medicaid Fraud Inspector jobs?

For Medicaid Fraud Inspector jobs, the most frequently searched job titles are:

Medicaid Fraud Inspector jobs near you
Infographic showing various Medicaid Fraud Inspector job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 80% Full Time, 18% Part Time, and 1% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution.

Assistant Director of Nursing

New City, NY • On-site

Jawonio
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Jawonioexternal

$100K - $110K/yr

Full-time

Re-posted 22 days ago

Key responsibilities

  • Oversee and ensure nursing services are provided according to job descriptions and regulatory standards.

  • Participate in quality improvement activities, review medical records, and monitor compliance with health plans and certifications.

  • Supervise, train, and evaluate nursing staff, and provide RN coverage as needed.

Job description

Purpose: The Assistant Director of Nursing will align his/her scope of work with Jawonio's Mission, while incorporating Jawonio's Core Values as the guiding principle for all work activities.
Summary: The Assistant Director of Nursing will provide comprehensive nursing services to persons living in the Jawonio Residences and programs. Will oversee the health activities in the residences and programs. Will provide oversight and supervision of assigned RN's and ensure they provide nursing services per their job descriptions.
Essential Duties and Responsibilities include the following. Other duties may be assigned. Note that employees may not be assigned all duties and responsibilities.
  1. Participates in quality improvement activities and ensures that records and documentation meet regulatory and professional standards.
  2. Ensures assigned RN's complete weekly nursing compliance checklists.
  3. Conducts ongoing reviews of medical records specific to Individual's health needs. Reviews records to maintain an accurate assessment of Individuals health condition and quality of care received ensuring compliance and audit readiness.
  4. Reviews Precision Care ensuring that written Plans of Nursing Services are up to date and accurately reflect each individuals' medical diagnoses.
  5. Monitors Medical Event tracking and alerts in Precision Care
  6. Monitors compliance of AMAP, G-tube & Insulin certifications are current
  7. Participate in on-site observation of nursing activities, including assessing nursing personnel's clinical judgment and competence
  8. Ensures that all corrective action plans are followed
  9. Trains all new nursing staff to ensure consistent orientation throughout CLS and Day Hab
  10. Performs supervisory functions including but not limited to coaching and redirecting, verbal, written counseling, initial training, periodic inspection, retaining and hiring. Contributes to the performance evaluations of RN, LPN, and CNA's.
  11. Assists in providing health related education to direct care staff
  12. Maintains collegial relationships with physicians and other health care providers
  13. Participates in Utilization Review & Quality Assurance projects
  14. Participates in Management meetings and Committees regarding the activities of the agency related to health care.
  15. Flexibility with schedule based on program needs
  16. Participates in rotation of the Emergency on Call Schedule
  17. Provides RN Coverage to an assigned Residence or Program
  18. Provides additional coverage in the absence of assigned RN when needed.

#INDNURSE
Education/Experience: Licensed by NYS to practice as a Registered Nurse, bachelor's degree preferred from an accredited nursing program, or three-year experience in a Supervisory position. A similar combination of education and experience will be considered.
Supervisory Responsibilities: This job has supervisory responsibilities.
Software: Working knowledge of Microsoft Office Suite, Smartboard presentations and ability to learn new software. Excel, Precision Care, Telemedicine, & EMR
Confidentiality: Ability to maintain the strictest confidentiality of all information accessed for data entry, filing, scanning or other purposes. Will be required to take annual confidentiality and HIPAA training.
Additional Requirements:
  • Daily access to an automobile is required. A valid New York State Driver's License is required.
  • Requires flexing regular schedule to accommodate operational needs.
  • Frequent contact with consumers, employees, and supervisory management.
  • Must be cleared by the Justice Center via fingerprinting and other background checks
  • Must be clear and maintain an acceptable record under the Medicaid Fraud & Abuse clearance process.
  • Remain current and up to date with First Aide/CPR certifications

Apply