Director, Medicaid Program Integrity - Remote

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.

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.

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