CVS Health
Kenner, Louisiana, United States
Program Integrity Manager (Must reside in state of Louisiana)
Posted over 1 month ago
Job Description
Job Description
Program Integrity Manager who is qualified by training and experience in health care or risk management, to oversee monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations, and carry out the provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigating unusual incidents and implementing any corrective action plans. As a management official, this position shall have the authority to assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to LDH and other duly authorized enforcement agencies. Position must report directly to the CEO.
-Oversees and or assists project team with creating complex queries, complex technical programming, and complex applications
-Works with advisers from key functional areas to understand potential project impact on the organization, align project work, and execute activities accordingly
-Presents to internal/external customers, constituents and business partners, strong business as well as systems knowledge and can perform reasonability checks
-Oversees the analysis, planning, design and development being performed by project team to support accurate maintenance of support systems for business areas
-Influences change or enhancements to business processes, policies and system infrastructure to improve information quality, availability and access
-Develops and participates in presentation and consultation to existing and prospective customers, business partners and internal business areas on information services, capabilities and performance results
-Negotiates resources in peer organizations to meet high priority department objectives
-Proactively evaluates project activities, builds contingency plans, executes corrective action, and monitors issue resolution to mitigate risks such as scope and/or budget variances
-Manages budget, plans and expenses
Required Qualifications
-Demonstrated ability to effectively coordinate multiple projects simultaneously
-Excellent verbal and written communication skills
-3-5 years of Demonstrated leadership and external facing experience
-Bachelor's degree or equivalent work experience
Preferred Qualifications
-3-5 years of data interpretation and analysis experience preferred
-3-5 years of project management experience preferred
Education
Bachelor's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Program Integrity Manager who is qualified by training and experience in health care or risk management, to oversee monitoring and enforcement of the fraud, waste, and abuse compliance program to prevent and detect potential fraud, waste, and abuse activities pursuant to state and federal rules and regulations, and carry out the provisions of the compliance plan, including fraud, waste, and abuse policies and procedures, investigating unusual incidents and implementing any corrective action plans. As a management official, this position shall have the authority to assess records and independently refer suspected member fraud, provider fraud, and member abuse cases to LDH and other duly authorized enforcement agencies. Position must report directly to the CEO.
-Oversees and or assists project team with creating complex queries, complex technical programming, and complex applications
-Works with advisers from key functional areas to understand potential project impact on the organization, align project work, and execute activities accordingly
-Presents to internal/external customers, constituents and business partners, strong business as well as systems knowledge and can perform reasonability checks
-Oversees the analysis, planning, design and development being performed by project team to support accurate maintenance of support systems for business areas
-Influences change or enhancements to business processes, policies and system infrastructure to improve information quality, availability and access
-Develops and participates in presentation and consultation to existing and prospective customers, business partners and internal business areas on information services, capabilities and performance results
-Negotiates resources in peer organizations to meet high priority department objectives
-Proactively evaluates project activities, builds contingency plans, executes corrective action, and monitors issue resolution to mitigate risks such as scope and/or budget variances
-Manages budget, plans and expenses
Required Qualifications
-Demonstrated ability to effectively coordinate multiple projects simultaneously
-Excellent verbal and written communication skills
-3-5 years of Demonstrated leadership and external facing experience
-Bachelor's degree or equivalent work experience
Preferred Qualifications
-3-5 years of data interpretation and analysis experience preferred
-3-5 years of project management experience preferred
Education
Bachelor's degree or equivalent experience
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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