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Job Description

Job Title: Manager, Medicaid Government Compliance
Job ID: 710972933
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Medicaid Compliance
Location: 600 Grant St, Pittsburgh PA 15219


UPMC's Medicaid Compliance group is seeking a Manager, Medicaid Government Compliance

In addition to the below tasks, this person ensures detailed familiarity with the requirements of the Department of Human Services (DHS) and the Centers for Medicare and Medicaid Services (CMS).

• Assist and support Senior Director in efforts to build, sustain, and expand (as needed) a cohesive and stable Compliance program
• Assist and support Senior Director in creating and maintaining positive trend of staff culture and employee engagement while growing Medicaid and CHC Compliance teams with minimal staff turnover
• Ensure timely and appropriate notification and escalation to Senior Director of concerns, issues, or questions and work to support the Senior Director in addressing as needed
• Ensure timely communication and training of key department personnel impacted by new or changed contractual or other compliance requirements
• Identify and work with Fraud, Waste, & Abuse department to establish benchmarks for fraud- and abuse-related transactions and implement policies and procedures as they apply to the Medicaid and CHC programs
• In collaboration with appropriate health plan departments and staff, develop and monitor implementation of corrective action plans to improve performance when necessary
• Establish and maintain an ongoing working relationship with key DHS personnel and other contacts as needed
• Monitor internal procedures to ensure the health plan continues to be compliant with all reporting requirements, including timeliness
• Oversee implementation of process and/or product changes or improvements on a day-to-day basis, as assigned
• Participate in the development of strategic and tactical business plans for company departments to achieve corporate business objectives and achieve operational compliance
• Perform ongoing analysis of client business problems, participate in identifying solutions, and ensure that the appropriate resolution occurs
• Provide contract analysis to determine impact on proposed changes as well as to provide summary documents and recommendations to key staff when necessary
• Understand the Pennsylvania HealthChoices and Community HealthChoices agreements in good detail
• Work collaboratively with internal staff members, as well as staff dedicated to the HealthChoices program from other departments to ensure effective program compliance and integration
• General supervision of Compliance staff to ensure individual and departmental responsibilities are being addressed as needed, including timely notification and escalation to Senior Director for any issues of concern (internal and external)
• Ownership of Medicaid Compliance Committee and CHC Compliance Committee preparation with appropriate Senior Director approvals, including updated key metrics dashboard, committee slides and content, attendee list, etc.
• Provide Senior Director with working draft of monthly Compliance updates for senior executive leadership no later than the 10th of each month, with minimal supervision and corrections/re-work
• Own and manage the Medicaid and CHC Corrective Action Plan process with appropriate reviews and approvals from Senior Director, including follow-up meetings with impacted business areas to track progress of CAP and review of applicable metrics
• Assist Senior Director in monitoring staff to ensure internal staffing needs and requirements are met


  • Bachelor's Degree from an accredited college or university. 
  • 5-10 years' experience in healthcare and/or Compliance environment. 
  • 4 years of management experience required. 
  • Successful experience with management of regulatory requirements and compliance. 
  • Demonstrated success in problem analysis and the design and implementation of project management plans, with emphasis on the plans that require cross-disciplinary and cross-departmental cooperation. 
  • The candidate must have excellent computer skills with emphasis on Microsoft Excel, Word, Access and other financial software packages. 
  • Experience must demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis as well as managing multiple tasks. 
  • The successful candidate will have demonstrated competency in attention to detail, organizational skills as well as interpersonal and political skills, strong communications, team and customer orientation, and ability to deal with ambiguity. 
  • This individual will also have extensive Medicaid product knowledge.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $35.66 to $60.38 / hour

Union Position: No

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