Manager - Program Integrity

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Manager – Program Integrity based in the United States. The Manager – Program Integrity plays a key role in protecting the integrity, quality, and effectiveness of healthcare and human services programs. This position oversees investigative teams, monitors operational performance, and develops strategies to prevent and detect fraud, waste, and abuse. Working across enterprise contracts, the role combines strategic oversight with hands-on investigation and risk management. You will collaborate with government agencies, regulatory bodies, and internal stakeholders to strengthen compliance and improve program outcomes. The position offers the opportunity to lead targeted investigations, optimize operational processes, and implement best practices in program integrity. As an independent leader, you will also mentor and develop teams while contributing to transparent, accountable, and high-quality service delivery. 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.