Senior Medicaid Program Integrity Lead — Iowa

Inspire Health Alliance; Des Moines, Northern (IA, KY); Hybrid; USD 77,000 - 116,000; Full time

Job summary

Sun Life U.S. is seeking an Iowa Program Integrity Manager to lead Medicaid program integrity, fraud prevention, and investigations. Based near Des Moines, this role oversees SIU activities, collaborates with state and federal agencies, and ensures CMS compliance while driving strategy and improvements.

You will work in a hybrid model, with in-office presence required at least 2 days weekly in Des Moines, IA, reporting to the Director of Regulatory Compliance & Program Integrity.

Qualifications

• Must reside in Iowa and have a Bachelor’s degree.
• 9+ years of experience in compliance, legal or regulatory functions or equivalent experience.
• Demonstrate knowledge in managing health care delivery, program integrity, utilization management, or public health program functions.

Responsibilities

• Provide leadership and strategic oversight of SIU activities.
• Participate in Fraud, Prevention, and Recovery operations.
• Collaborate with Clinical Quality Management to improve prevention activities.
• Develop and improve program integrity strategies aligned with Iowa Medicaid rules.
• Perform advanced data analysis to identify trends and program risks.
• Collaborate with state Medicaid agencies, CMS and law enforcement.
• Coordinate with Dental Directors for clinically sound investigations.
• Ensure investigations comply with CMS rules and internal policies.

Skills

Regulatory compliance leadership

Data analysis

Policy writing

Stakeholder collaboration

PowerPoint & Excel

Education

Bachelor's degree

Tools

PowerPoint

Excel

Job description

Sun Life U.S. is seeking an Iowa Program Integrity Manager to lead Medicaid program integrity, fraud prevention, and investigations. Based near Des Moines, this role oversees SIU activities, collaborates with state and federal agencies, and ensures CMS compliance while driving strategy and improvements.

You will work in a hybrid model, with in-office presence required at least 2 days weekly in Des Moines, IA, reporting to the Director of Regulatory Compliance & Program Integrity.