CareSource
Healthcare Insurance
CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.
1001 - 5000 employees
Founded 30+ years
⚕️ Healthcare Insurance
AVP – Program Integrity
Job not on LinkedIn
November 23
CareSource
Healthcare Insurance
CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.
1001 - 5000 employees
Founded 30+ years
⚕️ Healthcare Insurance
📋 Description
• Responsible for driving overall compliance, process and data Program Integrity • Formulates strategies to identify and address FWA risks • Monitors emerging FWA legislative and policy issues • Execute on Program Integrity strategy for multiple markets • Chairs the Investigations Committee • Collects Data and generates reports for Compliance Committee and Board • Collaborates with law enforcement and regulatory agencies • Prepares reports regarding identified FWA to state and federal agencies • Oversee Program Integrity Committee performance • Develop and implement standardized Program Integrity improvement initiatives
🎯 Requirements
• Bachelor’s degree or equivalent work experience in Law Enforcement, Accounting, or a Medical discipline • Minimum seven (7) years healthcare investigation experience • Minimum of five (5) years of leadership and management experience in managed care setting • Minimum of five (5) years of Program Integrity improvement in the healthcare or managed care industry • Advanced proficiency level with Microsoft Office • Data analysis and trending skills (SQL experience preferred) • NICB, IASIU, ACFE, or NHCAA certificates or training in healthcare fraud and abuse investigations are preferred
🏖️ Benefits
• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development opportunities • Bonuses
Apply NowSimilar Jobs
November 23
Regional Vice President managing sales and business relationships for Delaware Life in the Pacific Northwest. Driving sales growth and collaborating with internal teams for strategic initiatives.
November 22
Regional Vice President of Sales at Accela leading revenue-generating activities across the North West region. Driving success in customer retention and new business growth with an emphasis on cross-functional collaboration.
November 22
Vice President & General Manager, Academics directing GE HealthCare's academic strategy across the United States and Canada. Leading partnerships with academic institutions and driving healthcare innovation.
November 21
Vice President of Client Delivery connecting strategic vision and project execution at Egen. Leading client relationships and managing high-performing teams in a consulting environment.
November 21
Regional Vice President leading a sales team for SailPoint's Identity Management solutions. Responsible for revenue growth and team development in the North Central Territory.
🇺🇸 United States – Remote
💵 $157.4k - $292.4k / year
⏰ Full Time
🔴 Lead
👔 Vice President
🦅 H1B Visa Sponsor