Top 374 Healthcare program manager Jobs in Pennsylvania

Program Integrity Manager, Pennsylvania - Remote
UnitedHealthcare —Pittsburgh, PA
- $91,700 - $163,700 a year
- Full-time
- Remote
- Pass drug screening
- English
- Research
- Health insurance
Manager Provider Government Programs
Highmark Inc. —Pennsylvania
- $94,200 - $151,000 a year
- Full-time
- Hybrid work
- Office
- 3 years
- Master's degree
Healthcare Program Manager
Dental Beauty Inc —Feasterville-Trevose, PA
- $107,370 a year
- Full-time
- Management
- Mid-level
- In-person
- Dental insurance
- 401(k)
Quick Apply
7d
Service Director: Children's Program
Step by Step Inc. —Wilkes-Barre, PA
- $75,000 - $80,000 a year
- Full-time
- 3 years
- Master's degree
- Experience working with children
- Health savings account
- Health insurance
Quick Apply
Sleep Center Manager
Respiratory Specialists —Wyomissing, PA
- Full-time
- Background check
- Mid-level
- High school diploma or GED
- Health savings account
- Health insurance
Quick Apply
Regional Medical Director- (Philadelphia/Baltimore)
CareAllies —Philadelphia, PA
- $191,500 - $355,600 a year
- Full-time
- Remote
- Medicine
- 3 years
- Analysis skills
- Paid parental leave
- Paid holidays
Program Coordinator - Autism Services
Wesley Family Services —Wexford, PA
- $50,000 - $56,000 a year
- Weekends as needed
- Hybrid work
- LMFT
- Certified Nurse Practitioner
- Licensed Clinical Social Worker
- Paid parental leave
- Paid holidays
Quick Apply
Staff Veterinarian
Hendrix Genetics —Ephrata, PA
- Full-time
- English
- Continuous improvement
- Computer skills
Quick Apply
Program Manager Data & Analytics Healthcare
Partners Consulting, Inc. —Philadelphia, PA
- Contract
- Hybrid work
- Computer science
- Computer Science
- 5 years
Quick Apply
Senior Director Clinical Quality and Policy
Delta Dental —Camp Hill, PA
- $190,254 - $439,724 a year
- Full-time
- Hybrid work
- Background check
- Analysis skills
- Bachelor's degree
- Paid holidays
- Health insurance
Sr Dir, Pharmacy Business Ops - Pharmacy - Full Time
The Guthrie Clinic —Sayre, PA
- Full-time
- 6 years
- Finance
- Master's degree
Quick Apply
RN, Hospice Manager
Jewish Association on Aging —Pittsburgh, PA
- Full-time
- Nursing
- 5 years
- Administrative experience
- Free parking
- 403(b) matching
Quick Apply
Residential Coordinator
CHARTIERS CENTER —Bridgeville, PA
- Addiction Medicine
- Mid-level
- Residential
- Paid holidays
- Disability insurance
Quick Apply
11d
Hospice Clinical Liaison
Korn Ferry —Lancaster, PA
- Full-time
- CPR Certification
- Nursing
- Management
- Mileage reimbursement
- Paid holidays
Quick Apply
6d
Director of Plant / Environmental Operations
LECOM Medical Center and Behavioral Health Pavilion —Erie, PA
- Full-time
- Hospital
- 5 years
- Inpatient
- Health insurance
- Dental insurance
Quick Apply
Healthcare Operations Manager
LIFE Pittsburgh —Mc Kees Rocks, PA
- $55,000 - $68,750 a year
- Full-time
- Mid-level
- Master's degree
- Driver's License
- Health insurance
- Dental insurance
Quick Apply
Hospice Referral Liaison RN
Korn Ferry —Lancaster, PA
- Full-time
- CPR Certification
- Nursing
- Management
- Mileage reimbursement
- Paid holidays
Quick Apply
6d
Program Director - Registered Nurse
SeniorLIFE of PA —Greensburg, PA
- Full-time
- Background check
- Management
- Bachelor of Science
- Health insurance
- Dental insurance
Quick Apply
Hospice Sales Advocate RN
Korn Ferry —Lancaster, PA
- Full-time
- CPR Certification
- Nursing
- Management
- Mileage reimbursement
- Paid holidays
Quick Apply
6d
RN QAPI Coordinator
SeniorLIFE of PA —Johnstown, PA
- Full-time
- Background check
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance
Quick Apply
7d

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Program Integrity Manager, Pennsylvania - Remote

UnitedHealthcare -
Pittsburgh, PA

Apply Now

Job Details

Full-time
$91,700 - $163,700 a year

Benefits

Health insurance

Qualifications

Quality control corrective actions
Defect resolution root cause analysis
Productivity software
Root cause analysis

Full Job Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

UnitedHealthcare Community & State, part of the UnitedHealth Group family of companies, is looking for an experienced Health Plan Program Integrity / Fraud, Waste and Abuse compliance consultant to join our dynamic Compliance team. The Program Integrity Manager is an individual contributor role responsible for fraud, waste and abuse and specific research leading to best practice policy implementation and vendor/subcontractor monitoring to drive problem/process resolution for the New Mexico Medicaid health plan.

If you are located in Pennsylvania, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

Works to ensure that internal processes are executed, especially related to intersegment responsibilities, for fraud, waste, and abuse (FWA) vendors' instances of health care FWA by medical profession or insured member
Acts as FWA subject matter expert for Federal and local FWA regulations and subsequent regulatory policy and process implementation
Keeping apprised of current, proposed, and new federal and state regulations / guidelines
Ensures that changes in requirements are included in education and carried out by required audiences
Serves as health plan FWA trainer. Coordinates and supports implementation of FWA training and educational programs with the appropriate business areas and vendors
As necessary, gather and analyze all information and documents related to a FWA investigation
Acts as health plan FWA vendor liaison, i.e., conducts reviews on policies to make sure they are compliant; ensures that vendor processes are executed appropriately; that timelines are met per regulatory fulfillment; sets boundaries for vendors so that accountabilities are clear
Serves as regulatory FWA liaison to the regulatory entities and internally to key FWA organizational partners, including participation in meetings with regulators
Develops and maintains fraud-related policies, e.g., documents the education and hand-offs for the health plan from functional teams as required to meet contractual obligations
Oversees and ensures all required FWA regulatory reporting meets regulatory expectations
Ensures procedures are established to support timely communication and education regarding the fraud program
Ensures that procedures are in place to review and report possible violations in accordance with the reporting requirements as outlined in the FWA Plan. Reviews vendors to make sure that all aspects of FWA are managed and policies are developed where gaps are identified

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:

2+ years of experience in a FWA, investigations, regulatory, compliance, or related role
2+ years of experience working in a government, health care, managed care, insurance or related environment
Experience translating highly complex concepts in ways that can be understood by a variety of audiences
Experience identifying root cause issues and ensuring appropriate corrective action
Intermediate or higher proficiency using MS Word, MS Excel and MS PowerPoint

Preferred Qualifications:

Experience auditing medical billing and coding
Demonstrated ability to manage multiple projects and multiple relationships across the matrix
Demonstrated ability to stay organized and use time management skills
Demonstrated ability to work effectively and congenially with employees at all levels
Proven excellent written and verbal English communication skills

All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Apply Now

Refine Your Search

healthcare program manager jobs in pennsylvania

Program Integrity Manager, Pennsylvania - Remote

Manager Provider Government Programs

Healthcare Program Manager

Service Director: Children's Program

Sleep Center Manager

Regional Medical Director- (Philadelphia/Baltimore)

Program Coordinator - Autism Services

Staff Veterinarian

Program Manager Data & Analytics Healthcare

Senior Director Clinical Quality and Policy

Sr Dir, Pharmacy Business Ops - Pharmacy - Full Time

RN, Hospice Manager

Residential Coordinator

Hospice Clinical Liaison

Director of Plant / Environmental Operations

Healthcare Operations Manager

Hospice Referral Liaison RN

Program Director - Registered Nurse

Hospice Sales Advocate RN

RN QAPI Coordinator

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