Program Integrity Manager District of Columbia - Remote - 2171070I

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Job Code
2171070I
At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)
UnitedHealthcare Community & State, part of the UnitedHealth Group family of companies, is looking for an experienced Health Plan Program Integrity / Fraud, Waste and Abuse compliance consultant to join our dynamic Compliance team. The Program Integrity Manager is an individual contributor role responsible for fraud, waste and abuse and specific research leading to best practice policy implementation and vendor/subcontractor monitoring to drive problem/process resolution for the District of Columbia Medicaid health plan.
This position must reside within a commutable distance of our office in the District of Columbia. You will work in the office as needed and have the flexibility to work from home the rest of the time.
If you are located in District of Columbia, you will have the flexibility to work remotely* as you take on some tough challenges. This position must reside within a commutable distance of our office in the District of Columbia.
Primary Responsibilities:
Works to ensure that internal processes are executed, especially related to intersegment responsibilities, for fraud, waste, and abuse (FWA) vendors instances of health care FWA by medical profession or insured member
Acts as FWA subject matter expert for Federal and local FWA regulations and subsequent regulatory policy and process implementation
Keeping apprised of current, proposed, and new federal and state regulations / guidelines
Ensures that changes in requirements are included in education and carried out by required audiences
Serves as health plan FWA trainer. Coordinates and supports implementation of FWA training and educational programs with the appropriate business areas and vendors
As necessary, gather and analyze all information and documents related to a FWA investigation
Acts as health plan FWA vendor liaison, i.e., conducts reviews on policies to make sure they are compliant; ensures that vendor processes are executed appropriately; that timelines are met per regulatory fulfillment; sets boundaries for vendors so that accountabilities are clear
Serves as regulatory FWA liaison to the regulatory entities and internally to key FWA organizational partners, including participation in meetings with regulators
Develops and maintains fraud-related policies, e.g., documents the education and hand-offs for the health plan from functional teams as required to meet contractual obligations
Oversees and ensures all required FWA regulatory reporting meets regulatory expectations
Ensures procedures are established to support timely communication and education regarding the fraud program
Ensures that procedures are in place to review and report possible violations in accordance with the reporting requirements as outlined in the FWA Plan. Reviews vendors to make sure that all aspects of FWA are managed and policies are developed where gaps are identified
Youll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
2 years of experience in a FWA, investigations, regulatory, compliance, or related role
2 years of experience working in a government, health care, managed care, insurance or related environment
Experience translating highly complex concepts in ways that can be understood by a variety of audiences
Experience identifying root cause issues and ensuring appropriate corrective action
Intermediate or higher proficiency using MS Word, MS Excel and MS PowerPoint
Ability to perform this role in an office setting or other company location in the D.C. metro area, as necessary
Preferred Qualifications:
Bachelors degree
Experience auditing medical billing and coding
Demonstrated ability to manage multiple projects and multiple relationships across the matrix
Demonstrated ability to stay organized and use time management skills
Demonstrated ability to work effectively and congenially with employees at all levels
Proven excellent written and verbal English communication skills
Careers with UnitedHealthcare.
Work with a Fortune 5 organization thats serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - ****
Expires:
2023-07-01
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