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Fraud, Waste and Abuse (FWA) Manager - (241689)

Universal Health Services


Location:
RENO, NV
Date:
11/21/2017
2017-11-212017-12-20
Job Code:
3573
Universal Health Services
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Job Details

Deltek Talent Management - Fraud, Waste and Abuse (FWA) Manager - (241689)

Job Details


Fraud, Waste and Abuse (FWA) Manager - (241689)

Facility Name
Prominence Health Plan
Location
RENO, NV 89502 US (Primary)
Career Area
Professional
Category
Other
Job Description

Founded in 1978, Universal Health Services, Inc. (UHS)* is one of the nation’s largest and most respected healthcare management companies, operating through its subsidiaries—acute care hospitals, behavioral health facilities and ambulatory centers nationwide. With more than 74,000 people employed by UHS subsidiaries, UHS’s business strategy is to continue to grow by building or purchasing healthcare facilities across the country, while continuing to strengthen UHS’s well-reputed franchise with its customary exceptional service and effective cost control. Our success is driven by a service philosophy based on integrity, competence, compassion, and a responsive management style. UHS has been recognized as a Fortune 500 company and is listed as one of Fortune’s Most Admired Companies. UHS’s Acute Care Division is comprised of 25 high performing hospitals and several ambulatory care facilities across the nation and prides itself on providing superior patient care. 

Prominence Health Plan, established in Reno in 1993 as St. Mary’s Health Plan, was acquired in 2014 by Universal Health Services (UHS), one of Fortune Most Admired Companies. 

In addition to the HMO, Prominence Health Plan also offers Point of Service health plans, a preferred health insurance company that offers Preferred Provider Organization (PPO) health plans, and CDS Group Health, a third-party administrator.

We are a fast-growing, rapidly-changing healthcare organization offering the excitement of a start-up with the support of a Fortune 500 company. We are looking for talented, enthusiastic people to help shape the future of our organization.

Job Summary: The Fraud, Waste, and Abuse (FWA) Manager oversees, reviews and evaluates fraud, waste and abuse issues/concerns within the organization. The Manager will be analyzing, reporting and monitoring of the FWA efforts and providing recommendations to executive team on matters related to FWA compliance. The Manager demonstrates strong analytical acumen needed to analyze complex data, conduct risk assessment and identify areas vulnerable to fraud, waste, and abuse. The FWA Manager tracks and reports Company activities to ensure compliance with state and federal FWA requirements.

Job Requirements

Regulatory Requirements:

  • Bachelor’s degree in business, health administration or another related field
  • Minimum of five years of experience in health care compliance.​
  • Minimum of three years of experience of fraud, waste and abuse reporting and investigation in a healthcare environment.
  • Knowledge of state and federal laws and regulations applicable to fraud, waste and abuse as well as knowledge of reimbursement systems, coding, and billing
  • Knowledge and experience in information privacy laws, access, release of information, and release control technologies
  • Knowledge of statistics, report writing and data analysis techniques

 

Language Skills:

 

  • Ability to effectively communicate in English, both verbally and in writing.

     

Skills:

  • Strong  analytical, interpersonal, and problem-solving skills
  • Excellent oral and written communication skills
  • Demonstrates personal traits of a high level of integrity, team orientation, professionalism, and trustworthiness
  • Demonstrated organization, facilitation, communication, and presentation skills.

 

  • A minimum of three to five years of Medicare Advantage compliance related experience required

     

  • Experience with medical/legal issues in a healthcare environment preferred or an equivalent combination of education, training and experience.

     

 

 

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