Top 7 Health program manager Jobs in Idaho

Senior Compliance Investigator
Centene —Idaho
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
12d
Compliance & Risk Director | Full-Time | On site
North Canyon Medical Center, Inc. —Gooding, ID
- Full-time
- Management
- 3 years
- Bachelor's degree
Senior Fraud, Waste and Abuse (FWA) Specialist
PacificSource Health Plans —Boise, ID
- $65,296.83 - $111,004.62 a year
- Full-time
- Writing skills
- HIPAA
- English
Lead Director, Risk Adjustment Performance Reporting and Insights
CVS Health —Idaho
- $100,000 - $231,540 a year
- Full-time
- Remote
- Computer Science
- Bachelor's degree
- Mentoring
- Health insurance
- Dental insurance
Director of Regulatory Affairs - (Exempt)
Madisonhealth —Rexburg, ID
- Full-time
- Nursing
- RN License
- Bachelor of Science
- Health insurance
- Dental insurance

Discover related jobs

Based on your search for health program manager jobs.

Group Fitness Instructor- Meridian, ID
[solidcore] —Boise, ID
Please note, prior fitness teaching experience or fitness certification is not required. We offer all full-time employees participation in our Solidcares…
$24 per class
Quick Apply
Dental Hygienist
Post Falls Perio and Implants —Post Falls, ID
Valid Dental Hygiene license in the state of practice. Take and develop dental radiographs (X-rays). Your clinical expertise and patient-first mindset will play…
$55 - $60 an hour

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Credentialing Program Manager - Central Verification Office
OhioHealth —Columbus, OH
Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer,…
Credentialing Program Manager - Dublin
OhioHealth —Dublin, OH
Degree and two years’ experience in the healthcare, managed care, credentialing or medical staff services field or equivalent combination of education and 7+…

Show more jobs in cities nearby

I want to receive the latest job alert for health program manager in idaho

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

health program manager jobs near idaho

Fraud Analyst jobs in Boise, ID

Director Corporate Security jobs in California

Director Of Compliance jobs in Merrimack, NH

Director Of Compliance jobs in Tacoma, WA

Director Of Compliance jobs in Saint Paul, MN

Healthcare Compliance jobs in Phoenix, AZ

Director Of Compliance jobs in Miami, FL

Fraud Investigator jobs in Louisiana

Risk And Compliance Investigator jobs in Indiana

Risk And Compliance Investigator jobs in Minnesota

Risk And Compliance Investigator jobs in Oakland, CA

Risk And Compliance Investigator jobs in Memphis, TN

Investigator jobs in Delaware

Fraud Analyst jobs in Davie, FL

Fraud Analyst jobs in Itasca, IL

Fraud Analyst jobs in Greensboro, NC

Remote Data Analyst jobs in New York, NY

Fraud Remote jobs in Houston, TX

Systems Analyst jobs in Minneapolis, MN

Fraud Analyst jobs in Sunnyvale, CA

Senior Compliance Investigator

Centene -
Idaho

Apply Now

Job Details

Full-time
$70,100 - $126,200 a year
12 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Investigations regulatory compliance
Medical law
State healthcare regulations
Investigating compliance violations
Risk & issue management

Full Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Under the general direction of the VP of Compliance Investigations this position assists with the development, implementation, and continuous monitoring of an enterprise-wide Compliance Investigations Program and leads the Company's Compliance Investigations for all Business Units, Health Plans, and Corporate functions. Leads and oversees compliance and ethics investigations, facilitates and leads meetings with business management and cross-functional stakeholders, and prepares, reviews, and analyzes internal and external reporting. Supports the Director, Ethics & Investigations in the day-to-day operations of the Compliance Investigations Unit (CIU).

Leads and conducts compliance and ethics investigations across all business units and health plans, including but not limited to assessment of allegations, review of relevant documents, witness interviews, analysis of facts, root cause analysis, and preparation of investigation reports with recommended remedial or disciplinary actions.
Independently evaluates and assesses allegations to determine applicable criteria, including federal and state regulations, the Centene Code of Conduct, and internal policies, procedures, and standards that are alleged to have been violated.
Adheres to Compliance Investigation workplans and protocols and conducts investigations in compliance with established protocols and timelines.
Provides weekly case summaries and adheres to established minimum case review quotas to ensure timely progression and resolution of the investigative caseload.
Ensures all investigative findings are clearly tied to applicable company policies (e.g., Code of Conduct), federal and state regulations, and to maintain regulatory defensibility and support appropriate remediation.
Provides timely reports, both orally and in writing, to the Director of Ethics & Investigations and/or senior management regarding the status and outcomes of investigations.
Thoroughly documents, organizes, and reviews case files within centralized case management systems (e.g., Archer) in accordance with Company policy and CIU protocols.
Collaborates cross-functionally with other departments, including Legal, People Relations, SIU, Privacy, Finance, and Business Operations on investigations and the investigative process.
Prepares and analyzes departmental metrics, including investigation KPIs, case aging, and trending data, and makes recommendations accordingly.
Prepares presentations and presents findings to departmental and business management, executive leadership, and other stakeholders as needed.
Identifies risks, interprets investigation results, and recommends and communicates remedial actions to mitigate future potential risks.
Performs follow-up to ensure remedial/disciplinary measures are implemented appropriately and timely, including tracking remediation activities through case management systems.
Assists with various projects as assigned by the Director of Ethics & Investigations or the VP of Compliance Investigations.
Performs other duties as assigned.
Complies with all policies and standards.

Education/Experience:

A Bachelor's Degree in Related Field or Associates with 5 years of applicable experience, or a High School/GED with 6 years of applicable experience may substitute for the Bachelor's Degree, required.
4+ years of experience in investigations, auditing and risk analysis required.
1+ year of experience in reading, analyzing and interpreting State and Federal laws, rules and regulations required.

Preferred Qualifications:

Managed care or health insurance company experience preferred.
Experience with compliance case management systems (e.g., Archer, Navex) preferred.
Demonstrated experience conducting ethics and compliance investigations in a regulated healthcare environment preferred.
Experience collaborating with cross-functional teams including Legal, People Relations, SIU, and Privacy preferred.

Licenses and Certifications:

Certified Fraud Examiner (CFE) preferred.
Certified Compliance & Ethics Professional (CCEP) or Certified Healthcare Compliance (CHC) preferred.

Pay Range: $70,100.00 - $126,200.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

health program manager jobs in idaho

Senior Compliance Investigator

Compliance & Risk Director | Full-Time | On site

Senior Fraud, Waste and Abuse (FWA) Specialist

Lead Director, Risk Adjustment Performance Reporting and Insights

Director of Regulatory Affairs - (Exempt)

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for health program manager in idaho

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected