We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.(sm) The Lewin Group is a premier national health care and human services consulting and policy analysis firm with 45 years of experience finding answers and solving problems for leading organizations in the public, non-profit, and private sectors. Lewin's strategic and analytical services aim to help clients:Improve policy and expand knowledge of health care and human service systems Enact, run, and evaluate programs to enhance delivery and financing of health care and family services Deal with shifts in health care practice, technology, and regulation Optimize performance, quality, coverage, and health outcomes Create strategies for institutions, communities, associations, foundations, governments, and people to make health care and human services systems more effective In the wide-ranging field of human services consulting, The Lewin Group provides both depth and breadth of expertise. Lewin has more than 300 consultants drawn from industry, government and academia. They all share a strong commitment to Lewin's core values of objectivity, integrity, analytical innovation, vision and dedication to client satisfaction. The Lewin Group provides research and consulting services including program planning and development, implementation services, and post-implementation analytics and evaluation to assist the federal government in designing programs that improve the health and well-being of the nation's citizens. The Consultant will work on the West Virginia Medicaid Managed Care Administration Program. In this role, you will be an onsite analyst assisting the Bureau for Medical Services with all aspects of program integrity for the managed care program including oversight of fraud, waste and abuse monitoring and recoupment of recoveries. Primary Responsibilities:Oversight of managed care fraud, waste and abuse reportingDevelopment of strategies to improve Medicaid managed care program integrity effortsProviding guidance to the Bureau on compliance with federal and state policies and regulationsOngoing program monitoring activitiesFacilitating meetings with key stakeholdersCreating work plans and tracking project deliverables Reviewing MCO compliance with contractual requirementsCoordination with Medicaid fee-for-service program integrity efforts and the WV Medicaid Fraud Control Unit
Required Qualifications:Bachelor's Degree required with relevant experience3+ years of experience in Medicaid managed care or in reviewing Medicaid fraud, waste & abuse cases and issuing recovery notices Preferred Qualifications:Health care compliance, medical coding certification, or clinical background (i.e. RN)Experience working within a Medicaid Health Plan, Commercial Managed Care plan, health care provider, State Agency, or Consulting firmKnowledge of concepts and methodologies of State insurance programs, Managed Care and/or Medicaid health plansFamiliarity with West Virginia health care systemsGraduate degree Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: consultant, consulting, Medicaid, managed care, healthcare, health care, compliance, Charleston, WV, West Virginia
Internal Number: 747268
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.