Program Integrity Manager, DentaQuest - Must Reside in Iowa
Core
Lead and oversee Medicaid Managed Care program integrity operations, preventing and addressing fraud, waste, and abuse through special investigations and strategic oversight.
Role type
Senior Program Integrity Manager (Medicaid Managed Care)
Builds
Program integrity strategies, policies, and systems for Iowa Medicaid programs
Domain
Healthcare / Medicaid Managed Care / Regulatory Compliance
Deliverable
client delivery | dashboards & analysis
Required skills
Medicaid laws and regulations, program integrity, fraud detection and investigation, advanced data analysis, utilization review, policy development, government agency liaison, clinical quality management collaboration
Preferred skills
PowerPoint, advanced Excel, public health program functions, law enforcement organization experience
Responsibilities
Provide leadership and strategic oversight of Program Integrity and Special Investigations Unit (SIU) activities; Participate in Fraud, Prevention, and Recovery operations; Develop and implement program integrity strategies aligned with Iowa Medicaid rules; Perform advanced data analysis and drill-down utilization reviews; Collaborate with state Medicaid agencies, CMS, and law enforcement; Partner with Dental Directors to ensure investigative decisions are clinically sound; Ensure compliance with CMS rules and internal policies; Serve as primary client and provider liaison for investigations; Track investigations and manage workflows; Support policy and procedure improvements.
Seniority
Senior, hands-on IC with strategic oversight