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 escalate 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.
How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether?
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