Jobs in the United States

25+ jobs

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Team Captain Endzone & Loyalty (Front End)
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…inventory presentation, replenishment standards, etc. Promote and lead company programs (i.e., customer loyalty program participation, warranty sales, private label credit card enrollment,…
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Director, Medicaid Program Integrity - Remote

UnitedHealth Group · Eden Prairie, MN, United States · Colorado Springs, CO, United States · Nashville, TN, United States · Phoenix, AZ, United States · Saint Louis, MO, United States · Pittsburgh, PA, United States · Hartford, CT, United States · Dallas, TX, United States · Boulder, CO, United States · Tampa, FL, United States · $134,600 to $230,800 USD / year

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UnitedHealth Group

Director, Medicaid Program Integrity - Remote

Eden Prairie, MN, United States
Colorado Springs, CO, United States
Nashville, TN, United States
Phoenix, AZ, United States
Saint Louis, MO, United States
Pittsburgh, PA, United States
Hartford, CT, United States
Dallas, TX, United States
Boulder, CO, United States
Tampa, FL, United States

$134,600 to $230,800 USD / year

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Job details

Pay: $134,600 to $230,800 USD / year
Posting language: English
Posted: Nov 10, 2026

Original job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Medicaid Program Integrity Leader is responsible for developing, implementing, and overseeing Optum’s Medicaid program integrity strategies to assist State Agencies compliance with federal and state Medicaid regulations while preventing, detecting, and addressing fraud, waste, and abuse (FWA). This leader drives operational excellence through data analytics, audits, product insight, and collaboration with internal and external stakeholders. The role balances regulatory compliance, financial stewardship, and member/provider experience to safeguard Medicaid program resources.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

Strategic Leadership
Develop and execute the organization's Medicaid Program Integrity strategy
Establish goals, KPIs, and performance metrics aligned with organizational objectives
Lead program integrity operations across pre-payment, post-payment, and support development of new business operations
Serve as a subject matter expert on Medicaid integrity requirements and emerging regulatory guidance
Compliance & Regulatory Oversight
Ensure compliance with CMS, state Medicaid agencies, Office of Inspector General (OIG), and contractual requirements
Oversee preparation for audits, investigations, and regulatory reviews
Interpret federal and state regulations and translate them into operational policies and procedures
Maintain effective controls to support compliance and risk mitigation
Present findings, risks, and recommendations to executive leadership and governing committees
Data Analytics & Risk Management
Leverage advanced analytics to identify billing anomalies, emerging fraud schemes, and utilization trends
Establish predictive and retrospective monitoring programs
Utilize data-driven approaches to prioritize investigations and maximize recoveries
Monitor program integrity performance through dashboards and executive reporting
Financial Stewardship
Manage program integrity budgets and resources
Identify opportunities for cost avoidance, recoveries, and operational efficiencies
Quantify savings and return on investment for program integrity initiatives
Report financial outcomes to executive leadership
Team Leadership
Lead multidisciplinary teams including data analysts, developers, business analysts
Foster a culture of accountability, collaboration, and continuous improvement
Develop succession plans and talent management strategies
Mentor leaders and staff to strengthen organizational capabilities

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:

5+ years of healthcare, Medicaid, compliance, audit, investigations, or program integrity experience
5+ years of leadership experience managing teams and complex programs
5+ years of experience with fraud, waste, and abuse investigations and audit programs
2+ years of experience with Medicaid managed care regulations, CMS guidance, and program integrity requirements
2+ years of experience in data analytics and reporting capabilities
Excellent communication, executive presentation, and stakeholder management skills
Ability to travel up to 25%

Preferred Qualifications:

Certified Fraud Examiner (CFE), Certified Compliance & Ethics Professional (CCEP), Certified Internal Auditor (CIA), or similar certification
Experience with managed care organizations (MCOs), state Medicaid agencies, or healthcare payers
Knowledge of advanced analytics, predictive modeling, and AI-enabled fraud detection

Key Competencies:

Strategic Leadership
Regulatory Expertise
Fraud, Waste & Abuse Prevention
Healthcare Analytics
Risk Management
Financial Acumen
Executive Communication
Change Management
Team Development
Stakeholder Engagement

*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 $134,600 - $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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