Vice President of Program Integrity (Government Me

at WPS Health Solutions in Marion, Illinois, United States

Job Description


Who We Are
is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than . Proud to be military and veteran ready.
Culture Drives Our Success
WPS' Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
From 2021 to 2023, WPS Health Solutions was recognized for several awards:



Role Snapshot
The Vice President of Program Integrity is responsible for the oversight and execution of 2 large Medicare Administrator Contracts in our Government Health Administrators (GHA) line of business. In this role, you will lead operational areas including Provider Enrollment, Medical Policy, Outreach and Education, Data Analytics, and Medical Review to ensure all contractual requirements and award fee objectives are met/exceeded. Your direct reports will include a Clinical Medical Management Director, Provider Enrollment and Outreach and Education Director, Data Analytics Manager, and Contractor Medical Directors.
You will also collaborate extensively with the Centers for Medicare and Medicaid Services (CMS), Defense Health Agency (DHS), subcontractors, and internal/external partners to ensure contract success.
This position plays a critical role in contributing to the development of the Medicare Program Integrity Strategy. Building and maintaining positive relationships with stakeholders and partners will be key to the success of this role and our Government Health Administrators line of business.
Other responsibilities include:
Creating CMS,DHA,and corporate budget projections and directing key operational areas to ensure expenses and workload remain within funding limits.
Developing staffing requirements and technical responses for Requests for Proposals.
Directing activities leading to more efficient operations through innovations or process improvements.
How do I know this opportunity is right for me? If you:
Have strong presentation skills that clearly and effectively influence and communicate important. information to internal and external stakeholders.
Can engage actively with the diverse needs of internal stakeholders and possess an adaptable and flexible approach to meeting business needs.
Have proven success in leading activities that result in more efficient operations through innovations or process improvements.
Have extensive background in federal government contracting.
Communicate with confidence, clarity, and sound reasoning when discussing concerns, ideas, and suggestions.
Thrive in a highly collaborative, fast-paced, innovative and thriving environment.
What will I gain from this role?
The ability to work for a smaller organization that has proven success in the federal government contracting space doing claims administration and care management.
Active participation in business development and Request for Proposals.
Working with a highly skilled leadership team, focused on innovation, process improvements and honing a strategic path into the future.
The ability to build and maintain key relationships with internal and external stakeholders and strategic partners.
Experience working in an environment that serves our nation's military, veterans, Guard and Reserves, and Medicare beneficiaries.
Working in a continuous performance feedback environment.
Minimum Qualifications
Bachelor's Degree in related field or equivalent post high school and/or related work experience.
10 or more years of progressively responsible business experience, including 7 or more years of proven leadership/managerial experience.
Experience overseeing large government Medicare Administrator Contracts or health plan operations.
Proven experience building and leading strong collaborative teams in a thriving culture.
Ability to travel a few times a year when needed.
Preferred Qualifications
Experience overseeing... For full info follow application link.

Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.

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Job Posting: 11721503

Posted On: Mar 02, 2024

Updated On: Mar 09, 2024

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