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Optum, part of the UnitedHealth Group family of businesses, is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.
Program Integrity Manager - Kentucky - Remote
Location
Kentucky
Posted
41 days ago
Salary
$91.7K - $163.7K / year
Seniority
Junior
Job Description
Program Integrity Manager - Kentucky - Remote
Optum
Requisition Number: 2350752 At UnitedHealthcare, we're 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 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 Kentucky Medicaid health plan. If you are live in KY, you will have the flexibility to work remotely* as you take on some tough challenges. 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 You'll 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 - Driver's License and access to a reliable transportation Preferred Qualifications: - 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 *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Benefits
- 401(K), Dental insurance, Disability insurance, Employee stock purchase plan, Family medical leave, Flexible Spending Account (FSA), Generous parental leave, Generous PTO, Health insurance, Job training & conferences, Life insurance, Charitable contribution matching, Paid holidays, Paid sick days, Performance bonus, Tuition reimbursement, Vision insurance, Mental health benefits, Personal development training, Bereavement leave benefits
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