Manager - Program Integrity
About Our Client:
The organization is a not-for-profit corporation collaborating with public and private sectors to deliver high-quality, safe, and efficient health care and human services programs. It operates multiple business lines including population health, utilization review, managed care organization quality review, and quality assurance for services supporting individuals with developmental disabilities. The organization is recognized nationally for combating fraud, waste, and abuse within large entities and offers grant opportunities through its Foundation to programs serving underserved communities.
About the Opportunity:
The MANAGER - PROGRAM INTEGRITY plays a critical role in ensuring optimal performance of the Program Integrity division under enterprise contracts. This position is responsible for monitoring and analyzing performance metrics to drive improvements in processes and procedures. The manager oversees investigative teams, leads targeted reviews and intelligence efforts, and maintains communication with government agencies, regulatory bodies, and external stakeholders to uphold compliance and transparency. This role significantly impacts the integrity and effectiveness of program operations.
Responsibilities:
- Direct teams to ensure compliance with laws, regulations, and policies, prioritizing investigations and fraud schemes
- Identify and assess risks to program integrity and develop mitigation strategies
- Implement measures to maintain and enhance quality standards of program activities
- Develop and apply strategies to detect and prevent fraud, including controls and monitoring systems
- Independently evaluate processes for efficiency, effectiveness, and compliance
- Collaborate with internal departments and external entities to support program integrity
- Conduct advanced investigations into fraud, misconduct, or non-compliance and take corrective actions
- Maintain accurate documentation and generate reports on integrity metrics and compliance
- Educate program staff on compliance and integrity policies
- Manage team performance through feedback and formal reviews to ensure service quality and team development
Requirements:
- Minimum Bachelor's Degree or equivalent experience8 to 11 years of relevant experience required; 12 to 14 years preferred
- Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred
- Pay Range and Compensation Package:
The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.