Manager Investigations - Telecommute
Company: UnitedHealth Group
Location: Minnetonka
Posted on: May 5, 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)The Manager of Investigations reports directly
to the Associate Director of Investigations. The Manager of
Investigations is responsible for the direct oversight of
investigators whose primary roles are: identification,
investigation and prevention of healthcare fraud, waste and
abuse.You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. as you take on some tough challenges.Primary
Responsibilities:
- Managerial oversight of all types of fraud, waste and abuse
cases, to include all levels of complexity
- Ensure compliance with the UnitedHealthcare (UHC) Fraud, Waste
and Abuse Program
- Provide guidance to investigators on effective and efficient
investigative strategies
- Ensure investigators maintain accurate, current and thorough
case information in the Special Investigations Unit's (SIU's) case
tracking system
- Participate in settlement negotiations and/or produce
investigative materials in support of the later
- Collect, collate, analyze and interpret data relating to fraud,
waste and abuse referrals
- Ensure compliance of applicable federal/state regulations or
contractual obligations
- Ensure investigators compliance with goals, policies,
procedures and strategic plans as delegated by SIU leadership
- Collaborate with state/federal partners, at the discretion of
SIU leadership, to include attendance at work-groups or regulatory
meetingsYou'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 or Associate degree plus 2+ years of
equivalent work experience with healthcare related employment
-
- 3+ years of experience working in a government, legal,
healthcare, managed care and/or health insurance environment in a
regulatory, privacy or compliance/investigative role
- Broad knowledge and experience in health care fraud, waste and
abuse (FWA) investigations
- Broad knowledge and experience in state and federal regulatory
FWA requirements
- Proficient in developing investigative strategies
- Advanced level of proficiency in Microsoft Excel and Word
- Advanced level of knowledge with local, state/federal laws and
regulations pertaining to healthcare fraud, waste and abuse
(FWA)
- General knowledge of medical benefits, specialty benefits and
pharmacy benefits
- General knowledge of Compliance Program policies, procedures
and documentation standards
- Above average skills in data manipulation
- Ability to travel
- Full COVID-19 vaccination is an essential requirement 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 compliancePreferred Qualifcations:
- Active affiliations:
- National Health Care Anti-Fraud Association (NHCAA)
- Accredited Health Care Fraud Investigator (AHFI)
- Certified Fraud Examiner (CFE)
- Medical - If applicable
- Certified Professional Coder (CPC)
- Pharmacy - If applicable
- Certified Pharmacy Technician (CPhT)
- Broad knowledge in pharmacy claims processing
- Operational experience with a pharmacy and/or pharmacy benefits
manager (PBM)
- Demonstrated ability to supervise a team
- Demonstrated ability to communicate effectively, to include
written and verbal forms of communication
- 2+ years of direct supervisory experience
- Specialized knowledge/training in healthcare FWA
investigations
- Ability to participate in legal proceedings, arbitrations,
depositions, etc.
- Excellent skills in developing investigative strategiesTo
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 employmentCareers 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)Colorado, Connecticut
or Nevada Residents Only: The salary range for Colorado residents
is $82,100 to $146,900. The salary range for Connecticut / Nevada
residents is $90,500 to $161,600. Pay is based on several factors
including but not limited to education, work experience,
certifications, etc. 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.*All Telecommuters 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, Minnetonka , Manager Investigations - Telecommute, Executive , Minnetonka, Minnesota
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