Administrator for Program Integrity
About The Position
The Oregon Health Authority (OHA) is seeking an experienced leader to serve as the Administrator for Program Integrity within the Office for Program Integrity (OPI). This highly visible position provides strategic leadership for OHA’s statewide program integrity, fraud, waste, and abuse (FWA), and Medicaid compliance operations. Reporting directly to the Chief Financial Officer, the Administrator is responsible for setting priorities, developing policies and performance objectives, and ensuring OPI operations support OHA’s mission, strategic goals, and federal and state requirements. The Administrator leads a multidisciplinary team responsible for investigations, financial and compliance audits, data analytics, provider oversight, and Medicaid program integrity activities. This role serves as OHA’s leading authority on Medicaid FWA and is responsible for identifying emerging risks and trends, strengthening detection and investigation strategies, and using data and operational insights to improve program integrity. The Administrator also provides policy guidance to OHA leadership and ensures that program integrity activities promote responsible stewardship of Medicaid funds while supporting equitable access to health care. A significant part of this role involves building and maintaining strong partnerships across Oregon and at the federal level. The Administrator serves as OHA’s primary liaison with organizations including the Centers for Medicare & Medicaid Services (CMS), federal oversight agencies, the Oregon Department of Justice Medicaid Fraud Control Unit, the Secretary of State, other state agencies, contractors, health care providers, and community and industry partners. The position represents OHA in committees, task forces, and technical advisory groups and provides consultation, education, and technical assistance on Medicaid compliance and program integrity. In addition to strategic and operational leadership, the Administrator oversees OPI’s budget, contracts, staffing, strategic planning, and performance management. The position manages a complex portfolio of program integrity activities within OHA’s approximately $21 billion annual operation and exercises significant independent decision-making authority. This is an opportunity for a collaborative and strategic leader to help protect public resources, strengthen the integrity of Oregon’s Medicaid system, and advance OHA’s commitment to health equity, transparency, accountability, and high-quality services for Oregonians.
Requirements
- Five years of management experience; OR two years of management experience and a bachelor’s degree in a related field.
Nice To Haves
- Demonstrated experience leading or managing Medicaid program integrity, regulatory compliance, fraud, waste, and abuse (FWA), audit, investigation, or oversight activities.
- Demonstrated experience providing strategic direction, establishing priorities, developing performance objectives, and leading complex programs or multidisciplinary teams toward organizational goals.
- Experience overseeing or conducting complex investigations, audits, risk assessments, data analysis, or other activities designed to identify and address fraud, waste, abuse, overutilization, or program compliance concerns.
- Demonstrated experience working with federal, state, or local regulatory, oversight, law enforcement, or government entities on compliance, program integrity, audit, or related matters.
- Experience using audits, research, analytics, performance measures, financial information, or other data to identify trends, assess risk, improve operations, and inform policy or management decisions.
- Demonstrated ability to communicate complex regulatory, financial, operational, or compliance issues to executive leadership and build effective working relationships with diverse internal and external stakeholders.
- Seven (7) or more years of management experience
- Bachelor's degree with a master's degree preferred
- Demonstrated knowledge, skills, and abilities in fraud investigation, program integrity, regulatory compliance, and legal or administrative proceedings, including experience representing an organization in court or other formal proceedings, negotiating with defendants or involved parties, establishing and documenting credible allegations of fraud, and communicating complex investigative or compliance matters to legal counsel, executive leadership, regulatory agencies, and other stakeholders.
- Candidates whose experience reflects substantial depth and breadth in the identified work areas, including multiple years of progressively responsible experience, may be most competitive for this position.
- Additional years of relevant experience and demonstrated progression in responsibility, scope, or complexity of work.
Responsibilities
- Provides strategic leadership for OHA’s statewide program integrity, fraud, waste, and abuse (FWA), and Medicaid compliance operations.
- Sets priorities, develops policies and performance objectives, and ensures OPI operations support OHA’s mission, strategic goals, and federal and state requirements.
- Leads a multidisciplinary team responsible for investigations, financial and compliance audits, data analytics, provider oversight, and Medicaid program integrity activities.
- Serves as OHA’s leading authority on Medicaid FWA, identifying emerging risks and trends, strengthening detection and investigation strategies, and using data and operational insights to improve program integrity.
- Provides policy guidance to OHA leadership and ensures program integrity activities promote responsible stewardship of Medicaid funds while supporting equitable access to health care.
- Builds and maintains strong partnerships across Oregon and at the federal level, serving as OHA’s primary liaison with organizations including CMS, federal oversight agencies, the Oregon Department of Justice Medicaid Fraud Control Unit, the Secretary of State, other state agencies, contractors, health care providers, and community and industry partners.
- Represents OHA in committees, task forces, and technical advisory groups and provides consultation, education, and technical assistance on Medicaid compliance and program integrity.
- Oversees OPI’s budget, contracts, staffing, strategic planning, and performance management.
- Manages a complex portfolio of program integrity activities within OHA’s approximately $21 billion annual operation and exercises significant independent decision-making authority.
Benefits
- Excellent, low-cost medical, vision, and dental coverage for you and your family.
- Optional benefits like life insurance, disability coverage, deferred compensation, and FSA options for health and childcare.
- Generous paid time off: 11 holidays, 3 personal days, monthly sick leave, and vacation accrual starting at 8 hours/month for sick and 10 hours/month for vacation.
- Potential eligibility for the Public Service Loan Forgiveness Program.
- Retirement security through Public Employees Retirement System (PERS)/Oregon Public Service Retirement Plan (OPSRP).
- Training and development opportunities to grow your career with the State of Oregon.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
