Manager, Compliance – Program Integrity

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🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $109.2k - $144.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Program Manager

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WelbeHealth

WebsiteLinkedInAll Job Openings

501 - 1000 employees

⚕️ Healthcare Insurance

💰 $30M Series C on 2020-02

Healthcare Insurance

WelbeHealth is a healthcare organization that provides comprehensive medical care and personalized support to help seniors age well at home and in their communities. They offer a Program of All-Inclusive Care for the Elderly (PACE) which includes services such as medical care and coordination, dental, vision and hearing services, in-home care, prescription deliveries, transportation, physical therapy, meals, social activities, and more, often at no cost to eligible seniors. WelbeHealth's dedicated team prioritizes the needs of seniors by offering a coordinated approach to healthcare, ensuring access to highly skilled professionals across various areas of healthcare, and emphasizing patient-centered care. Their goal is to improve the quality of life for seniors by enabling them to live independently with robust support from a multidisciplinary team.

📋 Description

• Lead ongoing development, coordination, and oversight of the WelbeHealth FWA Prevention Program, including the prevention, detection, documentation, investigation, and resolution of potential FWA across WelbeHealth operations • Partner and coordinate with operational leadership to ensure alignment with all federal and state program integrity requirements, as well as industry best practices • Collaborate with Compliance leadership to establish, update, and maintain policies, procedures, and monitoring systems supporting FWA prevention and compliance • Provide subject-matter expertise and guidance to internal stakeholders on regulatory compliance matters related to FWA prevention and operations • Develop and deliver FWA prevention training programs for team members at all levels • Develop and maintain relationships with external entities, including CMS, law enforcement, vendors, and partner agencies, related to investigations and reporting requirements • Collaborate with internal auditors, legal counsel, and operational teams to support internal and external audits and investigations, ensuring timely and accurate responses, as well as track, analyze, and report on program integrity metrics, trends, and outcomes to the Senior Director, Corporate Compliance and oversight bodies as appropriate

🎯 Requirements

• Bachelor’s degree in healthcare administration, business administration, law, compliance, or a related field required • Advanced degree or professional certification such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), or Certified in Healthcare Privacy and Compliance (CHPC) preferred • Minimum of five (5) years of experience in a relevant field such as healthcare compliance, program integrity, FWA prevention, or fraud investigation oversight within a managed care or Medicare environment • In-depth knowledge of federal and state Medicare and Medicaid FWA regulations and healthcare compliance frameworks • Experience leading or conducting complex investigations including data analysis, documentation, and reporting • Strong ability to build effective cross-functional relationships with operational and leadership stakeholders.

🏖️ Benefits

• Medical insurance coverage (Medical, Dental, Vision) • Work/life balance - We mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days • 401K savings + match • Comprehensive compensation package including base pay and bonus • And additional benefits!