Manager - Program Integrity

Accountabilities: - Lead and oversee investigative teams, ensuring compliance with applicable laws, regulations, contractual obligations, and internal policies while prioritizing investigations and addressing emerging fraud schemes. - Identify, assess, and mitigate risks to program integrity by developing and implementing effective fraud prevention, detection, and monitoring strategies. - Monitor operational performance metrics, evaluate existing processes, and implement continuous improvement initiatives to enhance efficiency, effectiveness, and service quality. - Direct advanced investigations into suspected fraud, misconduct, waste, abuse, and non-compliance, coordinating appropriate corrective actions and follow-up measures. - Oversee targeted and strike force reviews, intelligence-driven targeting activities, and other investigative initiatives to identify and address program vulnerabilities. - Collaborate with internal departments, government agencies, regulatory bodies, and external partners to promote transparency, accountability, and consistent compliance practices. - Maintain accurate documentation of investigative activities, program performance, and compliance outcomes, preparing regular reports and communicating key findings to relevant stakeholders. - Provide guidance and training to program staff on compliance requirements, investigative procedures, and program integrity best practices. - Manage team performance through ongoing feedback, formal performance evaluations, coaching, and professional development initiatives that support engagement and high-quality service delivery. - Support senior leadership with contract operations, administrative responsibilities, and strategic initiatives that strengthen the overall performance of the Program Integrity division. Requirements: - Education: Bachelor's degree required, with relevant professional experience potentially considered as a substitute, depending on the position's requirements. - Professional experience: 8–11 years of relevant experience required, with 12–14 years preferred, particularly in program integrity, healthcare compliance, fraud investigations, risk management, or related fields. - Industry knowledge: Strong understanding of applicable laws, regulations, compliance frameworks, investigative procedures, and fraud prevention practices within healthcare or human services programs. - Investigative expertise: Demonstrated ability to conduct complex investigations, identify potential fraud schemes, assess risks, evaluate evidence, and implement effective corrective actions. - Leadership skills: Proven ability to supervise investigative teams, manage performance, provide constructive feedback, and develop a motivated, high-performing workforce. - Analytical capabilities: Strong skills in interpreting performance metrics, identifying operational weaknesses, assessing program effectiveness, and translating findings into actionable improvement strategies. - Communication and collaboration: Excellent written and verbal communication skills, with the ability to prepare clear reports, train staff, and build productive relationships with internal and external stakeholders, including government agencies. - Organizational skills: Ability to manage competing priorities, oversee multiple activities, maintain accurate records, and ensure consistent adherence to established standards. - Autonomy and judgment: Demonstrated capacity to work independently, make informed decisions, resolve complex issues, and elevate matters appropriately when needed. - Preferred certifications: Certified Fraud Examiner (CFE) or Accredited Healthcare Anti-Fraud Investigator (AHFI). Benefits: - Competitive compensation: Annual salary ranging from $92,295 to $120,000 , depending on qualifications and experience. - Remote work: Home-based, remote position within the United States, subject to the employer's location and eligibility requirements. - Leadership opportunities: The chance to lead investigative teams, influence program integrity strategies, and contribute to meaningful organizational improvements. - Professional development: Opportunities to strengthen expertise in healthcare compliance, fraud prevention, risk management, and investigative leadership. - Meaningful impact: Contribute to protecting healthcare and human services programs by helping prevent fraud, waste, and abuse while supporting accountability and quality of service delivery. - Collaborative environment: Work with multidisciplinary teams and external stakeholders, including government and regulatory organizations. - Additional benefits: Healthcare coverage, retirement plans, paid time off, and other employee benefits may be available; specific eligibility and details are determined by the employer. #J-18808-Ljbffr