Sr. Program Integrity Investigator

Overview

Are you looking to join a team of professionals who are passionate about serving Douglas County OHP members, engaging with the community, and delivering outstanding customer service? Umpqua Health is committed to recruiting top-tier team members who provide exceptional service with professionalism, compassion, and respect for the unique needs of every individual we serve. If you thrive in a fast-paced, dynamic healthcare environment and are ready to make a meaningful impact, you may be the team member we're looking for. We seek individuals who :

• Possess genuine compassion and empathy for our members
• Can adapt to ever-evolving healthcare regulations and requirements
• Are motivated by challenges and dedicated to delivering superior customer service

Join us in serving over 40,000 Douglas County residents as we administer Medicaid benefits and work together to improve health outcomes in our community.

Umpqua Health is a mission-driven, community-focused healthcare organization proudly serving Douglas County, Oregon. Locally owned by CHI Mercy Health and the Douglas County Individual Practice Association (DCIPA), we are deeply rooted in the region and dedicated to improving the health and well-being of our friends, families, and neighbors. Umpqua Health is the parent company of Umpqua Health Alliance, one of 16 Oregon coordinated care organizations serving the Oregon Health Plan. The Roseburg-based company and its subsidiaries are focused on expanding access, improving care, and reducing unnecessary costs across the clinical space for more than 40,000 Douglas County residents on the Oregon Health Plan and close to 10,000 more individuals with Medicare, private insurance or Exchange coverage.

Job Description

Position Purpose

Umpqua Health Alliance is seeking a seasoned Senior Program Integrity Investigator to lead complex fraud, waste, and abuse (FWA) investigations. This role is responsible for independently managing high-risk investigations, coordinating with regulatory and law enforcement agencies, and driving recovery and corrective action. The ideal candidate holds an AHFI designation and brings at least six years of experience in healthcare FWA investigations within a health plan, SIU, or regulatory agency.

Essential Job Responsibilities

Challenges

Qualifications

Minimum Qualifications

Preferred Qualifications

Physical Demands / Work Conditions

Equal Employment Opportunity

Umpqua Health is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.

Job Description Acknowledgement

I have reviewed the attached job description as outlined above and understand that I am responsible for all duties as outlined and other tasks as may be assigned. If I need accommodation to perform the essential functions of my job, I must contact my supervisor or Human Resources to begin an interactive process.

Note : This job description does not state or imply that these are the only duties to be performed. All duties are essential and subject to modification to reasonably accommodate individuals with disabilities. This document does not create an employment contract; it is at-will guidance.

About Umpqua Health

At Umpqua Health, we are a community-driven Coordinated Care Organization (CCO) serving Douglas County, Oregon, with a focus on primary and specialty care, behavioral health, and care coordination to improve member health outcomes. We are an equal opportunity employer committed to fairness and diversity and welcome applicants from all backgrounds.

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