Manager, Compliance (Program Integrity)

WelbeHealth

12h•$109,241 - $144,198

About The Position

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what. The Manager, Compliance is accountable for developing, implementing, and managing the enterprise-wide Fraud, Waste, and Abuse (FWA) Prevention Program. Reporting to the Senior Director, Corporate Compliance, this role is responsible for ensuring compliance with regulatory requirements, supporting audits and investigations, developing compliance training and corrective action plans (CAPs), and providing guidance on program integrity and operational compliance initiatives. This role is different because the Manager, Compliance at WelbeHealth: Leads and evolves our enterprise-wide FWA Prevention Program, serving as the organization's subject matter expert on program integrity while driving proactive strategies that strengthen regulatory compliance, reduce organizational risk, and protect the resources that support our participants Partners with leaders across Compliance, Operations, Legal, and Clinical teams to investigate complex FWA matters, implement sustainable CAPs, and build a culture of accountability, integrity, and continuous compliance throughout a growing, mission-driven healthcare organization

Requirements

Bachelor’s degree in healthcare administration, business administration, law, compliance, or a related field required
Minimum of five (5) years of experience in a relevant field such as healthcare compliance, program integrity, FWA prevention, or fraud investigation oversight within a managed care or Medicare environment
In-depth knowledge of federal and state Medicare and Medicaid FWA regulations and healthcare compliance frameworks
Experience leading or conducting complex investigations including data analysis, documentation, and reporting
Strong ability to build effective cross-functional relationships with operational and leadership stakeholders

Nice To Haves

Advanced degree or professional certification such as Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), or Certified in Healthcare Privacy and Compliance (CHPC) preferred

Responsibilities

Lead ongoing development, coordination, and oversight of the WelbeHealth FWA Prevention Program, including the prevention, detection, documentation, investigation, and resolution of potential FWA across WelbeHealth operations
Partner and coordinate with operational leadership to ensure alignment with all federal and state program integrity requirements, as well as industry best practices
Collaborate with Compliance leadership to establish, update, and maintain policies, procedures, and monitoring systems supporting FWA prevention and compliance
Provide subject-matter expertise and guidance to internal stakeholders on regulatory compliance matters related to FWA prevention and operations
Develop and deliver FWA prevention training programs for team members at all levels
Develop and maintain relationships with external entities, including CMS, law enforcement, vendors, and partner agencies, related to investigations and reporting requirements
Collaborate with internal auditors, legal counsel, and operational teams to support internal and external audits and investigations, ensuring timely and accurate responses, as well as track, analyze, and report on program integrity metrics, trends, and outcomes to the Senior Director, Corporate Compliance and oversight bodies as appropriate