Medicaid Program Integrity Lead – Iowa

Jobtailor; Des Moines (IA); On-site; USD 120,000 - 180,000; Full time

Job summary

Jobtailor is seeking a senior leader to oversee the DentaQuest Program Integrity and Special Investigations Unit. The role provides strategic direction for fraud prevention, compliance, and investigations within Iowa Medicaid guidelines.

The position requires deep knowledge of Medicaid managed care regulations, senior leadership experience with government agencies, and strong data analytics capabilities. In-person collaboration with state and federal stakeholders is essential.

Qualifications

• Bachelor’s degree required.
• “9+ years of experience in compliance, legal or regulatory functions” or equivalent.
• Experience with Medicaid Managed Care laws and program integrity preferred.
• Ability to interpret and communicate laws and regulations to leadership.

Responsibilities

• Lead and oversee DentaQuest Program Integrity and Special Investigations Unit activities.
• Provide strategic direction and oversight of special investigations and fraud, waste, and abuse prevention activities.
• Collaborate with state Medicaid agencies, CMS, and law enforcement on investigations and policy.
• Develop, implement, and improve program integrity strategies aligned with Iowa Medicaid rules.
• Perform advanced data analysis to identify utilization trends and program risks.
• Ensure investigative actions comply with CMS rules and internal policies.

Skills

Fraud prevention

Data analysis

Regulatory compliance

Leadership

Policy development

Communication

Investigation skills

Education

Bachelor’s degree

Tools

Excel

PowerPoint

Job description

Jobtailor is seeking a senior leader to oversee the DentaQuest Program Integrity and Special Investigations Unit. The role provides strategic direction for fraud prevention, compliance, and investigations within Iowa Medicaid guidelines.

The position requires deep knowledge of Medicaid managed care regulations, senior leadership experience with government agencies, and strong data analytics capabilities. In-person collaboration with state and federal stakeholders is essential.