Director, Program Integrity, Health & Human Services

The KPMG Advisory practice is at the forefront of transformation, offering excellent opportunities for individuals to advance their careers and expertise with KPMG. Looking ahead, we anticipate continued evolution and success within the practice, fostering both personal and professional development, thereby creating new pathways for growth. In this ever-changing market environment, our professionals must be adaptable and thrive in a collaborative, team-driven culture. At KPMG, our people are our number one priority. With a wealth of learning and career development opportunities, a world-class training facility, and leading market tools, we help our people continue to grow both professionally and personally. If you're looking for a firm with a strong team connection where you can be your whole self, have an impact, advance your skills, deepen your experiences, and have the flexibility and access to constantly find new areas of inspiration and expand your capabilities, then consider a career in Advisory.

KPMG is currently seeking a Director, Program Integrity, Health & Human Services to join our Advisory Services practice.

Responsibilities:

• Provide technical and strategic advisory services related to program integrity, compliance, and fraud, waste, and abuse (FWA) across Health and Human Services (HHS) programs, including Medicaid, HR1-related programs (such as SNAP), rural health, childcare, child welfare, and child support enforcement; Support the design, implementation, and operation of end to end program integrity frameworks, including policy and procedure development, governance models, internal controls, and operating structures
• Lead and oversee risk assessments, gap assessments, and fraud risk assessments to identify program vulnerabilities and prioritize integrity and compliance activities; Direct and support compliance reviews, audits, investigations, and third party/subrecipient monitoring, including desk and field audits; design and oversee FWA prevention and detection strategies, leveraging data analytics, automated flags, trend analysis, dashboarding, and reporting
• Develop and monitor corrective action plans (CAPs) and continuous improvement efforts to remediate findings and strengthen program controls; Support provider and participant integrity activities, including credentialing, background checks, eligibility-related reviews, and forensic analysis
• Provide guidance on regulatory compliance with federal and state requirements and translate policy and regulatory expectations into practical, operational solutions; Provide program integrity leadership across financial, reimbursement, and fiscal administration functions, including rate setting, cost reporting, managed care oversight, and federal claiming, to identify and mitigate fraud, waste, and improper payments
• Contribute to KPMG's thought leadership by authoring professional articles, participating in industry and regulatory forums, and speaking at external events on program integrity and FWA topics; as well as lead and actively participate in business development efforts, including client relationship management, proposal development, and expansion of program integrity services across HHS clients
• Oversee team operations by planning, scheduling, and assigning work; provide leadership in recruiting, developing, and retaining talent to grow the program integrity practice
• Act with integrity, professionalism, and personal responsibility to uphold KPMG's respectful and inclusive work environment

Qualifications:

• Minimum eight years of recent and applicable experience in program integrity, compliance, audits, investigations, or FWA-related roles, supporting federal or state HHS programs, including Medicaid and/or human services programs (such as SNAP, child welfare, childcare, child support enforcement)
  
• Advanced degree from an accredited college or university is preferred; Minimum of a Bachelor's degree is required; preferred certifications include CFE, CGFM, PMP, CPA or other relevant credentials
• Strong working knowledge of federal and state laws, regulations, and guidance governing Medicaid and human services programs
• Experience designing and executing program integrity strategies, compliance reviews, and FWA prevention and detection initiatives; experience in Medicaid finance, healthcare finance, reimbursement, or fiscal administration, including roles such as Medicaid CFO, Deputy CFO, finance director, or consulting roles supporting state HHS or Medicaid agencies
• Demonstrated experience with Medicaid rate setting, cost reporting, managed care financial oversight, federal claiming, or financial audits, and their intersection with program integrity and compliance.
• Demonstrated experience leading teams and managing complex, multi-disciplinary engagements, with an active role in execution and delivery; proven success in client service and business development within an advisory or consulting environment; exceptional interpersonal and communication skills, with the ability to build credibility and trust with senior government and organizational leaders
• Willingness to travel as needed, which may be up to eighty percent
• Applicants must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. KPMG LLP will not sponsor applicants for U.S. work visa status for this opportunity (no sponsorship is available for H-1B, L-1, TN, O-1, E-3, H-1B1, F-1, J-1, OPT, CPT or any other employment-based visa)

KPMG LLP and its subsidiaries ("KPMG") complies with all local/state regulations regarding displaying salary ranges. If required, the ranges displayed below or via the URL below are specifically for those potential hires who will work in the location(s) listed. Any offered salary is determined based on relevant factors such as applicant's skills, job responsibilities, prior relevant experience, certain degrees and certifications and market considerations. In addition, KPMG is proud to offer a comprehensive, competitive benefits package, with options designed to help you make the best decisions for yourself, your family, and your lifestyle. Available benefits are based on eligibility. Our Total Rewards package includes a variety of medical and dental plans, vision coverage, disability and life insurance, 401(k) plans, and a robust suite of personal well-being benefits to support your mental health. Depending on job classification, standard work hours, and years of service, KPMG provides Personal Time Off per fiscal year. Additionally, each year KPMG publishes a calendar of holidays to be observed during the year and provides eligible employees two breaks each year where employees will not be required to use Personal Time Off; one is at year end and the other is around the July 4th holiday. Additional details about our benefits can be found towards the bottom of our KPMG US Careers site at Benefits & How We Work.
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KPMG offers a comprehensive compensation and benefits package. KPMG is an equal opportunity employer. KPMG complies with all applicable federal, state and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, citizenship status, disability, protected veteran status, or any other category protected by applicable federal, state or local laws. The attached link contains further information regarding KPMG's compliance with federal, state and local recruitment and hiring laws. No phone calls or agencies please.
KPMG recruits on a rolling basis. Candidates are considered as they apply, until the opportunity is filled. Candidates are encouraged to apply expeditiously to any role(s) for which they are qualified that is also of interest to them.
Los Angeles County applicants: Material job duties for this position are listed above. Criminal history may have a direct, adverse, and negative relationship with some of the material job duties of this position. These include the duties and responsibilities listed above, as well as the abilities to adhere to company policies, exercise sound judgment, effectively manage stress and work safely and respectfully with others, exhibit trustworthiness, and safeguard business operations and company reputation. Pursuant to the California Fair Chance Act, Los Angeles County Fair Chance Ordinance for Employers, Fair Chance Initiative for Hiring Ordinance, and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.