Program Integrity Manager
Core
Ensuring compliance with state and federal requirements, preventing fraud, waste, and abuse (FWA), and overseeing regulatory and contractual obligations for health programs.
Role type
Senior IC program integrity manager (healthcare compliance & FWA)
Builds
Operational effectiveness and program integrity for health plans and managed care programs
Domain
Healthcare + Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Program Integrity, Payment Integrity, Special Investigations, Healthcare Compliance, Fraud Waste and Abuse (FWA), Claims Operations, Healthcare Operations, Regulatory Reporting, Audit Coordination, Vendor Management, Provider Reimbursement, Payment Accuracy
Preferred skills
Medicaid managed care, SIU investigations, fraud prevention programs, operational oversight, claims operations
Technologies
None explicitly stated
Responsibilities
Supporting Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities; coordinating reporting and audit activities; partnering with internal and external stakeholders to promote operational effectiveness; ensuring compliance with applicable requirements
Seniority
Senior, hands-on IC
