Manager, Medicaid Integrity Operations, Financial Crime and Fraud

Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.

Work You'll Do

As a Manager, Financial Crime Services, you will:

• Oversee delivery across multiple state Medicaid program integrity engagements, including statement of work, milestones, service levels, quality standards, and client commitments.
• Direct operational planning, resource allocation, delivery reviews, risk identification, escalations, and corrective action planning in coordination with project managers and account leaders.
• Directly supervise assigned project managers, auditors, analysts, program integrity specialists, and other delivery personnel as appropriate to the contract portfolio.
• Provide senior expertise in Medicaid provider oversight, claims auditing, prepayment and postpayment review, payment integrity, fraud and abuse detection investigations, and improper payment recovery.
• Guide risk-based audit and review approaches, provider billing assignments, emerging scheme identification, documentation standards, and defensible findings.
• Apply first-hand understanding of state Medicaid agency operations and private sector vendor delivery to align contracted services with agency objectives and operational realities.
• Serve as a senior operational liaison between agency program integrity leaders and internal teams clarifying requirements, resolving issues, and improving execution.
• Define and monitor performance measures for contract delivery, staff productivity, quality, audit effectiveness, prevention, recovery and client satisfaction.
• Maintain appropriate documentation, quality assurance, reporting and operational controls; support responses to audits and oversight reviews.
• Contribute Medicaid program integrity expertise to proposals climate solution demonstrations, client discovery, and new contract operational planning.
• Surface emerging client needs, program integrity risks, and opportunities for product or service improvements to executive and product leadership.

The successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team
• Effective written and verbal communication skills
• Meticulous attention to detail and quality of work product
• Ability to build and sustain professional relationships
• Ability to lead projects or workstreams
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment
• Strong interpersonal skills and professional demeanor
• Ability to meet deadlines
• Ability to provide clear guidance to others

The Team

Deloitte's Government & Public Services (GPS) practice - our people, ideas, technology and outcomes - is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Our Enterprise Operations & Risk offering enables clients to achieve profitable growth and competitive advantage by optimizing "heart of the business" operations. Leverages deep domain expertise to extend enterprise resilience, agility and remediation. Addresses client needs which span the organization and impact strategy, operations, performance and reputation.

Qualifications

Required:

• Bachelor's degree
• 10+ years of progressively responsible experience in Medicaid program integrity, payment integrity, healthcare auditing, compliance, or related government healthcare operations.
• 5+ years of leadership experience managing personnel, operational teams, program integrity initiatives, contracts, or complex health care programs.
• Ability to travel 5-25%, on average, based on the work you do and the clients and industries/sectors you serve.
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future

Preferred:

• Experience with Medicaid recovery audit contractors, prepayment predictive analytics, post payment review, provider audits, and improper payment recovery.
• Experience procuring, implementing, or operationally managing program integrity technology, claims processing, analytics, or pace management tools.
• Experience with vendor contracts, procurement, statements of work, regulatory audits, corrective action activities, or legislative and executive presentations.
• Experience working with Midwestern state Medicaid agencies, including familiarity with regional program integrity priorities, operations, and stakeholder environments.
• Certified Professional Coder (CPC), Certified Program Integrity Professional (CPIP), or comparable professional certification.

The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $110,700 to $184,500.

You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance.