Medicaid Program Integrity Manager – Iowa

DentaQuest; Des Moines (IA); Hybrid; USD 77,000 - 116,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) match

Stock purchase options

Discretionary annual incentive

Job summary

Sun Life U.S. embraces a hybrid work model balancing in-office collaboration with virtual work. The Iowa Program Integrity Manager leads Medicaid Managed Care integrity operations, guiding investigations, and shaping strategies with state and federal partners.

This senior role requires healthcare delivery and program integrity expertise, data analysis, and policy development. Based near Des Moines, IA, the role is full-time with access to claims data and investigative resources to safeguard

Qualifications

• Bachelor’s degree from an accredited four-year college or university is required.
• 9+ years of experience in compliance, legal or regulatory functions or equivalent.
• Knowledge of Medicaid Managed Care program health care delivery and program integrity.
• Ability to interpret laws, evaluate regulations, and update policies and procedures.
• Experience coordinating with government agencies, law enforcement, and clients.

Responsibilities

• Provide leadership and strategic oversight of SIU activities.
• Oversee fraud, prevention, and recovery operations to curb waste and abuse.
• Collaborate with Clinical Quality Management to enhance prevention efforts.
• Develop and refine program integrity strategies aligned with Iowa Medicaid.
• Perform advanced data analysis to identify utilization trends and risks.
• Engage with state/federal agencies, CMS, and managed care organizations.
• Ensure investigations and actions are well-documented and compliant.
• Serve as client liaison for investigations and reporting requirements.

Skills

Program integrity

Data analysis

Fraud prevention

Policy development

Leadership

Regulatory compliance

Communication

Project management

PowerPoint

Advanced Excel

Education

Bachelor’s degree

Regulatory or health-care background

Tools

PowerPoint

Excel

Job description

Sun Life U.S. embraces a hybrid work model balancing in-office collaboration with virtual work. The Iowa Program Integrity Manager leads Medicaid Managed Care integrity operations, guiding investigations, and shaping strategies with state and federal partners.

This senior role requires healthcare delivery and program integrity expertise, data analysis, and policy development. Based near Des Moines, IA, the role is full-time with access to claims data and investigative resources to safeguard