Top 23 senior program manager Jobs in jacksonville fl

Sr Director Special Investigation Unit
GuideWell —Jacksonville, FL
- $136,000 - $221,000 a year
- Full-time
- CPA
- Office
- 3 years
- Wellness program
- Disability insurance
Senior Manager 1, Program Manager and Managing Editor, Reporting Team
Deloitte —Jacksonville, FL
- $113,100 - $232,300 a year
- Full-time
- Remote
- English
- Research
- Continuous improvement
4d
Senior Specialist, Quality Program Management & Performance (Remote)
Molina Healthcare —Jacksonville, FL
- $54,922 - $107,099 a year
- Full-time
- Remote
- RN License
- Mid-level
- Analysis skills
- Health insurance
Senior Manager, Technical Program Management
Scribd, Inc. —Jacksonville, FL
- $125,500 - $228,500 a year
- Full-time
- 5 years
- Residential
- Analysis skills
- Paid parental leave
- Disability insurance
Memory Care Program Manager
Brookdale Senior Living Inc. —Jacksonville, FL
- $21.97 - $27.47 an hour
- Full-time
- Mid-level
- Residential
- Supervising experience
- Health savings account
- Paid holidays
Quick Apply
12d
Senior GME Program Admin-Emergency Medicine-Full-time-Days
UF Health —Jacksonville, FL
- Full-time
- University
- Bachelor's degree
- Travel
- Travel reimbursement
Senior Director, Alternative Risk Underwriter
Fortegra —Jacksonville, FL
- $175,000 - $200,000 a year
- 11+ years
- Office
- Finance
- Disability insurance
- Health insurance
Quick Apply
Nephrology Nurse RN Educator-Coordinator kidney care preferred
Chen Medical Associates —Jacksonville, FL
- $76,732 - $109,617 a year
- Full-time
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement
Senior Program Manager (5379)
Three Saints Bay, LLC —Orange Park, FL
- Online Application
- Background check
- 3 years
- Senior level
Quick Apply
Senior Consultant, Risk Management
Deloitte —Jacksonville, FL
- Weekends as needed
- Microsoft Excel
- Marketing
- Research
Manager, Program/Project-Sr.
Orbis, Inc. —Mayport, FL
- Bachelor's degree
- Organizational skills
- Senior level
Sr Director, Program Management - CIO
FIS Global —Jacksonville, FL
- Full-time
- Pass drug screening
- Bachelor's degree
- Experience equivalent to degree accepted
8d
Patient Educator, Specialty (RN)
Chen Medical Associates —Jacksonville, FL
- $76,732 - $109,617 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Opportunities for advancement
7d
Corporate Governance Manager Senior
FIS Global —Jacksonville, FL
- Full-time
- Pass drug screening
- Finance
- 8 years
7d
Sr Director, Compensation-Total rewards
Nemours —Jacksonville, FL
- Full-time
- Analysis skills
- Bachelor's degree
- Continuous improvement
Regional Manager, Ambulatory Pharmacist
Chen Medical Associates —Jacksonville, FL
- $128,686 - $183,837 a year
- Weekends as needed
- Up to 50% travel
- English
- Outpatient
- Opportunities for advancement
Home Health Clinical Manager
First Senior Home Health - Orange Park —Orange Park, FL
- CPR Certification
- Nursing
- RN License
Quick Apply
Lead Cardiologist
Conviva Senior Primary Care —Jacksonville, FL
- $360,500 - $495,700 a year
- Full-time
- Medicine
- Outpatient
- Clinic
- Mileage reimbursement
- Paid parental leave
SENIOR COMMUNITY HEALTH NURSE - 64000065
The State of Florida —Yulee, FL
- $48,000 - $52,000 a year
- Background check
- School experience
- Nursing
- Paid holidays
- Dental insurance
Senior Program Manager
Brooksource —United States
- $60 - $65 an hour
- Full-time
- Remote
- 7 years
- Senior level
- Leadership
- Health insurance
- Dental insurance
Quick Apply
8h

I want to receive the latest job alert for senior program manager in jacksonville fl

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

senior program manager jobs near jacksonville fl

Senior Manager Of Technical Product Management jobs in Jacksonville, FL

Risk Manager jobs in Jacksonville, FL

Registered Nurse jobs in Jacksonville, FL

Director Of Program Management jobs in Jacksonville, FL

Regional Manager jobs in Jacksonville, FL

Memory Care Director jobs in Jacksonville, FL

Senior Underwriter jobs in Jacksonville, FL

Nurse Educator jobs in Jacksonville, FL

Senior Manager Of Technical Product Management jobs in Denver, Co

Product Owner jobs in Boston, Ma

Senior Manager Of Technical Product Management jobs in Woonsocket, Ri

Senior Manager Of Technical Product Management jobs in Home, Pa

Product Manager jobs in Seattle, Wa

Senior Manager Of Technical Product Management jobs in Reno, Nv

Utilization Management Social Worker jobs in New York, Ny

Senior Program Manager jobs in Boise, Id

Senior Program Manager jobs in Wilmington, De

Senior Software Engineer jobs in Madison, Wi

Safety Manager jobs in Chicago, Il

Senior Program Manager jobs in Cherry Hill, Nj

Sr Director Special Investigation Unit

GuideWell -
Jacksonville, FL

Apply Now

Job Details

Full-time
$136,000 - $221,000 a year

Benefits

Wellness program
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
Volunteer time off
Life insurance
Retirement plan

Qualifications

Affordable Care Act (ACA)
Vendor relationship building
Healthcare financial misconduct investigations
Stakeholder engagement
Investigations regulatory compliance
Medicare
Medical law
Team leadership
CMS
Internal investigations
CMS regulatory compliance
Investigative data analysis
Health insurance knowledge
Medicare regulations
Collaborating with law enforcement agencies
Leading team collaboration initiatives
Insurance investigations
Audit support
Senior leadership

Full Job Description

Job Summary
The Sr. Director, Special Investigation Unit (SIU) is responsible for developing and implementing organization-wide strategies to prevent, detect, and refer for prosecution fraud, waste and abuse (FWA) involving providers, members, agents, and other stakeholders. Key responsibilities include: (i) monitoring and participating in national and regional information-sharing groups to stay informed about emerging trends and schemes and proactively identifying potential risks and vulnerabilities for the Company; (ii) collaborating with Senior Leaders across the organization to enhance FWA detection and prevention efforts; and (iii) leading a team of highly specialized staff and fostering effective working relationships with vendors, the Blue Cross Blue Shield Association (BCBSA), and state and federal agencies.

Key Responsibilities:
Strategic Leadership:
• Develop and implement comprehensive strategies and high-level tactics to prevent and detect FWA involving providers, members, agents and other stakeholders.
• Create and execute business plans to drive FWA prevention and detection efforts, leveraging expertise to identify opportunities for policy improvement, reform, or creation.
• Collaborate with Senior Leaders across the organization to strengthen overall FWA detection and prevention efforts, considering new initiatives in response to regulatory, health benefit coverage, or technological changes.
• Collaborate closely with the Payment Integrity Office to identify and prioritize high-risk areas for FWA and develop joint strategies to address these risks.
• Prepare and present updates and reports to the Audit, Risk and Compliance Committee and Corporate Ethics and Compliance Committee on SIU activities, including risks, new and emerging schemes, performance metrics and case results.
Investigations and Data Analysis:
• Collaborate with internal stakeholders to identify opportunities to integrate artificial intelligence and machine learning into SIU workflows, enhancing investigative capabilities and improving FWA detection and prevention efforts.
• Develop and maintain a proactive approach to detecting FWA, building cases for investigation and prosecution as needed. Oversee multiple FWA data mining and analysis projects, investigations, and initiatives, ensuring compliance with federal and state regulations.
External Representation:
• Represent the Company in various forums, including depositions, testimony, and intelligence sharing sessions in support of FWA actions.
• Participate in provider disputes, settlement negotiations, arbitrations, administrative hearings, and criminal proceedings, as required.
Collaboration and Stakeholder Engagement
• Develop and maintain effective relationships with internal and external stakeholders to combat FWA.
• Collaborate with the compliance department to share status updates and referrals to the MEDIC, CMS and other regulatory agencies; participate in regulatory examinations, as needed.
• Work closely with Legal Affairs on litigation matters, ensuring effective coordination and support.
• Develop and maintain leadership positions in national organizations, such as the National Health Care Anti-Fraud Association and BCBSA, to stay informed about industry trends and best practices.
Vendor Management
• Manage and maintain effective relationships with external data mining vendors, ensuring high-quality services and effective collaboration.
Implement FWA awareness program
• Develop employee training to raise the level of FWA awareness.
• Provide FWA awareness presentations to internal departments, external entities and customers.
Leadership and Talent Development
• Provide leadership and direction to the SIU, overseeing the detection, investigation, and disposition of FWA cases.
• Manage a team of employees across multiple offices, ensuring effective coordination and collaboration.
• Set clear goals and objectives for the SIU, aligning with organizational priorities and strategic objectives.
Financial Management and Planning
• Develop and manage the SIU's operating plan and budget, ensuring alignment with organizational goals and objectives, strategic priorities, and resource allocations.

Required:
• 10+ years' related work experience - combination of fraud investigations, auditing, data analysis and compliance.
• Broad knowledge of health care industry practices and applicable regulatory requirements.
• Strong knowledge of government program requirements (e.g., Medicare, Affordable Care Act).
• 3+ years’ direct supervisory/management experience.
• Related bachelor's degree or additional equivalent work experience.
• Extensive knowledge of fraud and auditing concepts and strong investigatory skills.
• Excellent interpersonal and proven leadership skills with a demonstrated ability to establish relationships with senior executives across all business units.
• Proven skills at developing and maintaining effective working relationships with a variety of federal, state, and local law enforcement agencies or similar experience.

Preferred:
• Certified Fraud Examiner (CFE) or Accredited Healthcare Fraud Investigator (AHFI) designation
• Master’s degree or higher in accounting, business, criminal justice, law or related field
• CPA – Certified Public Accountant
• Knowledge of state and federal laws and regulations relating to healthcare and prosecution of healthcare offenses.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally

What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

Medical, dental, vision, life and global travel health insurance;
Income protection benefits: life insurance, short- and long-term disability programs;
Leave programs to support personal circumstances;
Retirement Savings Plan including employer match;
Paid time off, volunteer time off, 10 holidays and 2 well-being days;
Additional voluntary benefits available; and

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Annualized Salary Range: $136,000 - $221,000

Typical Annualized Hiring Range: $136,000 - $170,000

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Apply Now

Refine Your Search

senior program manager jobs in jacksonville fl

Sr Director Special Investigation Unit

Senior Manager 1, Program Manager and Managing Editor, Reporting Team

Senior Specialist, Quality Program Management & Performance (Remote)

Senior Manager, Technical Program Management

Memory Care Program Manager

Senior GME Program Admin-Emergency Medicine-Full-time-Days

Senior Director, Alternative Risk Underwriter

Nephrology Nurse RN Educator-Coordinator kidney care preferred

Senior Program Manager (5379)

Senior Consultant, Risk Management

Manager, Program/Project-Sr.

Sr Director, Program Management - CIO

Patient Educator, Specialty (RN)

Corporate Governance Manager Senior

Sr Director, Compensation-Total rewards

Regional Manager, Ambulatory Pharmacist

Home Health Clinical Manager

Lead Cardiologist

SENIOR COMMUNITY HEALTH NURSE - 64000065

Senior Program Manager

I want to receive the latest job alert for senior program manager in jacksonville fl

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected