Program Manager, Health Plan Payment Integrity (Claims & Recovery) Remote
Molina Healthcare · United States · US
Healthcare Consulting
Remote
Not yet analysed
Demand75
Career growth65
Healthcare fit62
Remote potential100
5-year outlook
Likely competitive mid-to-senior payer operations compensation, with growth tied to regulatory scrutiny and value-based care. Exact salary is not stated in the posting.
Clinical license
Not required
Applicant reach
narrow
Seniority
senior
Employment type
full-time
Date found
2026-11-08
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth applying if you already have managed care claims, payment integrity, or payer business analyst experience. Pure clinicians without MCO or claims operations exposure may find the experience gap too high.
Who should apply
Clinicians with prior health plan, claims, revenue cycle, managed care, or payer operations experience; nurses or doctors who have worked in utilization review, quality, compliance, or health plan business analysis.
CV angle
Reframe real clinical or healthcare experience around claims data, coding (CPT/ICD/HCPCS/Revenue Codes), regulatory compliance, quality metrics, data analysis, and cross-functional project management. Quantify any payer, claims, recovery, or managed care work where possible.
Skills to highlight
- Managed care claims processing
- Payment integrity
- CPT/ICD/HCPCS/Revenue Codes
- Medicaid and Medicare regulations
- Data analysis and visualization
- Project management
- Stakeholder collaboration
- Regulatory compliance
Role summary
Program manager overseeing health plan payment integrity, including pre-pay edits, overpayment recovery, claims accuracy, and CMS/state regulatory compliance.
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