Manager Investigations - Telecommute in Louisiana

UnitedHealth Group Remote
manager telecommute fraud compliance health waste pharmacy healthcare investigators regulations manager it oversight
September 23, 2022
UnitedHealth Group
Baton Rouge, Louisiana

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.

If you are located within a commutable distance to Baton Rouge, you will have the flexibility to telecommute* 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 meetings

You 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 Associates degree plus two 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
  • Advanced level of knowledge with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse (FWA)
  • Broad knowledge and experience in health care fraud, waste and abuse (FWA) investigations
  • General knowledge of medical benefits, specialty benefits and pharmacy benefits
  • General knowledge of Compliance Program policies, procedures and documentation standards
  • Advanced level of proficiency in Microsoft Excel and Word
  • Ability to travel
  • Full COVID-19 vaccination is an essential job function 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 compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • 2+ years of direct supervisory experience
  • Specialized knowledge/training in healthcare FWA investigations
  • 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)

  • Above average skills in data manipulation
  • Excellent skills in developing investigative strategies
  • Ability to supervise a team
  • Ability to communicate effectively, to include written and verbal forms of communication
  • Ability to participate

To 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 employment

Careers 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)

*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.

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