Manager - Program Integrity
New
J
JobgetherHealthcare program integrity
Home-based, remote position within the United StatesFull-TimeManager
Salary92,295 - 120,000 USD per year
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Job Details
- Experience
- 8–11 years of relevant experience required, with 12–14 years preferred
- Required Skills
- Risk Management
Requirements
- Bachelor’s degree required; relevant professional experience may be considered as a substitute, depending on position requirements.
- 8–11 years of relevant experience required; 12–14 years preferred.
- Relevant experience in program integrity, healthcare compliance, fraud investigations, risk management, or related fields.
- Strong understanding of applicable laws, regulations, compliance frameworks, investigative procedures, and fraud prevention practices in healthcare or human services programs.
- Ability to conduct complex investigations, identify potential fraud schemes, assess risks, evaluate evidence, and implement corrective actions.
- Ability to supervise investigative teams, manage performance, provide feedback, and develop staff.
- Ability to interpret performance metrics, identify operational weaknesses, assess program effectiveness, and develop improvement strategies.
- Written and verbal communication skills for preparing reports, training staff, and working with stakeholders, including government agencies.
- Ability to manage competing priorities, oversee multiple activities, maintain accurate records, and adhere to established standards.
- Ability to work independently, make informed decisions, resolve complex issues, and escalate matters appropriately.
- Certified Fraud Examiner (CFE) or Accredited Healthcare Anti-Fraud Investigator (AHFI) certification preferred.
Responsibilities
- Lead investigative teams and ensure compliance with laws, regulations, contractual obligations, and internal policies.
- Develop and implement fraud prevention, detection, and monitoring strategies.
- Monitor operational performance metrics and implement continuous improvement initiatives.
- Direct investigations into suspected fraud, misconduct, waste, abuse, and non-compliance, and coordinate corrective actions.
- Oversee targeted reviews, strike force reviews, and intelligence-driven targeting activities.
- Collaborate with internal departments, government agencies, regulatory bodies, and external partners.
- Maintain investigative and compliance documentation, prepare reports, and communicate findings to stakeholders.
- Provide guidance and training on compliance requirements, investigative procedures, and program integrity practices.
- Manage team performance through feedback, evaluations, coaching, and professional development.
- Support senior leadership with contract operations, administrative responsibilities, and strategic initiatives.
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