Description

As the Assistant Director of Medicare Advantage Audit and Fraud Compliance, you'll play a crucial role in safeguarding our health plan resources and upholding regulatory standards.

In this role, you'll develop and execute strategies to detect and address non-compliance, Fraud, Waste, and Abuse (FWA) within our Medicare Advantage and Prescription Drug programs. Leading a team of managers, you'll oversee internal audits, FWA detection through data mining, and ensure compliance with CMS and DMHC regulations.

Key responsibilities include:

• Oversee aspects of the Medicare Advantage Prescription Drug Anti-Fraud, Special Investigations Unit (SIU), and Audit Programs through subordinate managers.

• Develop and implement strategies to detect non-compliance and FWA using data mining and internal audits.

• Ensure compliance with regulatory requirements related to non-compliance, FWA, and SIU.

• Guide strategic goals to manage health plan resources effectively and align with broader system initiatives.

• File necessary documentation with CMS and DMHC to demonstrate compliance or identify risk areas.

Salary Range: $140,200 - $331,800/annually

Qualifications

We're seeking a results-driven, experienced leader with:

• A Bachelor's degree in Business Administration, Healthcare, or a related field, required

• Eight or more years of relevant compliance experience in a Medicare Managed Care environment, required

• Five or more years of leadership experience managing personnel in a Medicare Managed Care setting, required

• Certification as a Certified Internal Auditor (CIA) or Certified Fraud Examiner (CFE), required

• Proven ability to build and lead high-performing teams

• Experience interacting with regulatory agencies and auditors

• Strong familiarity with Medicare regulations and CMS expectations or best practices

• Additional certifications such as CIFI or CHC are a plus

UCLA Health welcomes all individuals, without regard to race, sex, sexual orientation, gender identity, religion, national origin or disabilities, and we proudly look to each person’s unique achievements and experiences to further set us apart.