Program Integrity Manager – Ohio Remote

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

No other industry is changing as rapidly or as broadly as health care. But to us, change is invigorating. It gives us a chance to continue to innovate as we shape the future. As a Program Integrity Manager with us, you will monitor changes to laws and regulations to ensure compliance with State and Federal mandates. It’s an exhilarating pace where you can develop your career while you help to make the health system work better for everyone.

The Program Integrity Manager is an individual contributor role responsible for FWA (Fraud, Waste, and Abuse), specific research leading to best practice policy implementation, and vendor monitoring to drive problem / process resolution, including the Ohio Medicaid Health Plan and other states, as assigned.

If you reside within the state of Ohio, 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 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
• Responsible for keeping apprised of current, proposed, and new federal and state regulations / guidelines
• Ensures that changes in requirements are included in FWA education and carried out by required audiences in a timely manner
• Serves as health plan FWA trainer. Coordinates and supports implementation of FWA training and educational programs with the appropriate business areas and affected vendors
• As necessary, gather and analyze all information and documents related to a FWA investigation
• Collaborates with vendor relationship leadership of affected vendors and acts as health plan FWA vendor liaison, i.e., conducts reviews on policies to make sure the affected vendors 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
• Acts as a backup to Compliance Director to ensure that timelines and requests for information are met
• Develops and maintains FWA – 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 FWA 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:

• 5+ years of experience working in a government, legal, health care, managed care and/or health insurance environment in a regulatory, privacy or compliance role
• Project management experience
• Experience working with state regulators, including Medicaid Fraud Control Units
• Experience working in a matrixed environment
• Experience communicating complex information via phone conversations and emails to non-technical clients, external customers, internal customers and executives
• Experience interacting & collaborating with a variety of stakeholders (other team members, internal customers, and executives)
• Intermediate or better proficiency with MS Word, MS Excel and MS Outlook

Preferred Qualification:

• Experience working with Medicare, Medicare Advantage, Medicare Part D, Medicaid and/or Tricare regulations

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employers 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-free workplace. Candidates are required to pass a drug test before beginning employment