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Program Integrity Manager - Remote - Must Reside in Ohio

Company: UnitedHealth Group
Location: Houston
Posted on: November 27, 2022

Job Description:

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with 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 Compliance Consultant 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 Ohio Medicaid health plan.

If you are located in Ohio, you will have the flexibility to work remotely* as you take on some tough challenges. -

Primary Responsibilities:


  • Proficient in their ability to understand and analyze health care claims and coding
  • Identifies risks, and guards against fraud, waste, and abuse throughout the MCO's service delivery system
  • Actively monitors for aberrant providers
  • Refers potential fraud, waste, and abuse to ODM as required
  • Actively participates in any meetings as required
  • Establish, mandate and implement standard policies, procedures and best practices across the company to promote compliance with applicable laws and contractual obligations
  • Conduct state-specific legal research and monitor changes in requirements to mitigate risks and achieve compliance
  • Support the collection of data for regulatory filings, coordinate and develop reports, projects and use assessment tools to verify compliance
  • Predict emerging customer needs and develops innovative solutions to meet them
  • Develop compliance communications and drive problem resolution for a business segment - across UnitedHealth Group
  • Answering inquiries from the regulator. -
  • Coordinating/performing periodic audits and ad hoc visits
  • Experience interacting & collaborating with a variety of stakeholders (other team members, internal customers, and executives)



    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:


    • Bachelor's degree with a minimum of 2+ years of experience in the healthcare field working in fraud, waste, and abuse investigations, compliance, or audits; or Associate's degree, with a minimum of 4+ years of experience working in health care fraud, waste, and abuse investigations, compliance, or audits
    • 2+ years of experience communicating complex information via phone conversations and emails to non-technical clients, external customers, internal customers, and executives
    • Live in the state of Ohio
    • Ability to travel
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation


      Preferred 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
      • Experience working with Medicare, Medicare Advantage, Medicare Part D, Medicaid and/or Tricare regulations
      • Intermediate or better proficiency with MS Word, MS Excel and MS Outlook



        To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

        Careers with UnitedHealthcare. -Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do -your life's best work.(sm)

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


        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 - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Houston , Program Integrity Manager - Remote - Must Reside in Ohio, Executive , Houston, Texas

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