Remote Director, Medicaid Program Integrity & Analytics

Optum; Eden Prairie (MN); Remote; USD 135,000 - 231,000; Full time

Job summary

OptumInsight is transforming how health data flows to improve care and reduce costs. The Medicaid Program Integrity Leader will develop and oversee strategies that ensure compliance with CMS and state regulations while preventing fraud, waste, and abuse.

The role offers remote work across the U.S., with in-office requirements in certain locations. You will lead cross-functional teams, leverage analytics, and drive continuous improvement in program integrity operations.

Qualifications

• 5+ years in healthcare, Medicaid, compliance, or program integrity.
• 5+ years leading teams and complex programs.
• 5+ years in fraud, waste, and abuse investigations and audits.
• 2+ years with Medicaid managed care regulations and CMS guidance.
• 2+ years in data analytics and reporting.

Responsibilities

• Develop and execute the organization's Medicaid Program Integrity strategy.
• Set goals, KPIs, and performance metrics aligned with objectives.
• Lead program integrity operations across pre- and post-payment.
• Serve as SME on Medicaid integrity requirements and guidance.
• Oversee audits, investigations, and regulatory reviews.
• Translate regulations into operational policies and procedures.
• Present findings and recommendations to executives.

Skills

Leadership

Data analytics

Stakeholder management

Executive communication

Program integrity

Regulatory knowledge

Travel readiness

Job description

OptumInsight is transforming how health data flows to improve care and reduce costs. The Medicaid Program Integrity Leader will develop and oversee strategies that ensure compliance with CMS and state regulations while preventing fraud, waste, and abuse.

The role offers remote work across the U.S., with in-office requirements in certain locations. You will lead cross-functional teams, leverage analytics, and drive continuous improvement in program integrity operations.