Top 2947 Outcomes 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
6d
Finance Managed Services Manager - Controllership & Record-to-Report (R2R) | Life Sciences & Healthcare (LSHC) Industry
Deloitte —Philadelphia, PA
- $122,000 - $240,500 a year
- Full-time
- 6 years
- Oracle
- CPA
4d
PBM Account Manager - Remote
Optum —Philadelphia, PA
- $72,800 - $130,000 a year
- 8 hour shift
- Remote
- Pass drug screening
- Mid-level
- Travel
Quick Apply
1d
Manager Provider Government Programs
Highmark Inc. —Pennsylvania
- $94,200 - $151,000 a year
- Full-time
- Hybrid work
- Office
- 3 years
- Master's degree
12d
Clinical Quality Manager - Remote in Pennsylvania
UnitedHealthcare —Fort Washington, PA
- $91,700 - $163,700 a year
- Full-time
- Remote
- RN License
- Writing skills
- Pass drug screening
7d
Investigations Manager
Allegheny County Pennsylvania —Allegheny County, PA
- $93,000 - $117,000 a year
- Online Application
- Background check
- Management
- Office
Client Success Manager (Client Management III) - REMOTE
Net Health —Pittsburgh, PA
- $80,039 a year
- Remote
- 5 years
- Mid-level
- Bachelor's degree
- Health insurance
Quick Apply
13d
Program Manager (Murrysville, PA)
Philips —Murrysville, PA
- $121,000 - $193,000 a year
- Full-time
- Writing skills
- Office
- Travel
- Health savings account
- Employee stock purchase plan
Program Manager - Risk Adjustment
Highmark Inc. —Pennsylvania
- $94,200 - $151,000 a year
- Full-time
- Hybrid work
- 7 years
- Office
- High school diploma or GED
3d
Customer Experience, Program Manager | Central & Northeast Region
iRhythm Technologies, Inc. —Pennsylvania
- $115,000 - $149,000 a year
- Full-time
- Remote
- Up to 50% travel
- Master's degree
- Bachelor's degree
Quick Apply
Finance Managed Services Manager - Controllership & Record-to-Report (R2R) | Consumer Industry
Deloitte —Philadelphia, PA
- $122,000 - $240,500 a year
- Full-time
- 6 years
- Oracle
- CPA
4d
Manager, Nursing - Post Anesthesia Care Unit - Full Time
The Guthrie Clinic —Sayre, PA
- Full-time
- Nursing
- 5 years
- Master's degree
Quick Apply
RN / Patient Care Manager, Home Health
AccentCare, Inc. —Marysville, PA
- $90,000 - $105,000 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Health savings account
- Paid holidays
Quick Apply
RN Registered Nurse Unit Manager
WeCare at Sycamore —Montoursville, PA
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
7d
Global Facility Engineering Manager
Greene, Tweed —Kulpsville, PA
- $130,000 - $145,000 a year
- Full-time
- Office
- Bachelor's degree
- US work authorization
- Health insurance
- Dental insurance
Quick Apply
8d
Registered Nurse (RN) Unit Manager
Highlands Rehabilitation & Healthcare Center —Muncy Valley, PA
- Full-time
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
Senior Civil Engineer and Deputy Office Manager
KS Engineers, P.C. —Philadelphia, PA
- $130,000 - $160,000 a year
- Full-time
- Hybrid work
- Construction site
- 11+ years
- Office
- Commuter assistance
- Paid holidays
Quick Apply
Branch Manager (Retail & Business Banking)
Quaint Oak Bank —Southampton, PA
- $80,000 - $95,000 a year
- Full-time
- Background check
- Mid-level
- Office
- Health savings account
- Health insurance
Quick Apply
6d
Clinical Supervisor
Pinnacle Treatment Centers —Johnstown, PA
- Full-time
- Nursing
- Medicine
- Management
- Loan repayment program
- Disability insurance
6d
Business/Project Development Manager - Northeast
Carboline Global Inc. —Pittsburgh, PA
- Full-time
- 5 years
- Ability to lift 50 pounds
- Business development
- Health insurance
- Dental insurance
Quick Apply

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Program Integrity Manager, Pennsylvania - Remote

UnitedHealthcare -
Pittsburgh, PA

Apply Now

Job Details

Full-time
$91,700 - $163,700 a year
6 days ago

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

outcomes manager jobs in pennsylvania

Program Integrity Manager, Pennsylvania - Remote

Finance Managed Services Manager - Controllership & Record-to-Report (R2R) | Life Sciences & Healthcare (LSHC) Industry

PBM Account Manager - Remote

Manager Provider Government Programs

Clinical Quality Manager - Remote in Pennsylvania

Investigations Manager

Client Success Manager (Client Management III) - REMOTE

Program Manager (Murrysville, PA)

Program Manager - Risk Adjustment

Customer Experience, Program Manager | Central & Northeast Region

Finance Managed Services Manager - Controllership & Record-to-Report (R2R) | Consumer Industry

Manager, Nursing - Post Anesthesia Care Unit - Full Time

RN / Patient Care Manager, Home Health

RN Registered Nurse Unit Manager

Global Facility Engineering Manager

Registered Nurse (RN) Unit Manager

Senior Civil Engineer and Deputy Office Manager

Branch Manager (Retail & Business Banking)

Clinical Supervisor

Business/Project Development Manager - Northeast

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