Manager - Program Integrity
About The Position
The Manager - Program Integrity is responsible for ensuring optimal performance of the Program Integrity division across enterprise contracts. The role monitors and analyzes performance metrics to identify opportunities to improve processes and procedures, and supports the Senior Manager - Program Integrity with contract operations and administration. The manager oversees investigative teams' day-to-day activities and leads targeted/strike force reviews and intelligence targeting. The role also serves as a regular liaison with government agencies, regulatory bodies, and other external stakeholders to support transparent, compliant programs. Qlarant is a not-for-profit corporation partnering with public and private sectors to support high-quality, safe, and efficient health care and human services programs. Its work spans population health, utilization review, managed care organization quality review, quality assurance for programs serving individuals with developmental disabilities, and efforts to combat fraud, waste, and abuse. The Qlarant Foundation provides grant opportunities to programs serving underserved communities.
Requirements
- Minimum bachelor's degree, which may be substituted for experience.
- 8–11 years of experience required; education may be substituted for experience.
Nice To Haves
- 12–14 years of experience preferred.
- Certified Fraud Examiner certification preferred.
- Accredited Healthcare Anti-fraud Investigator certification preferred.
Responsibilities
- Direct teams to monitor compliance with relevant laws, regulations, and organizational policies, and prioritize and collaborate on investigations and fraud schemes.
- Identify and evaluate potential program-integrity risks and develop mitigation strategies.
- Implement measures to maintain and improve the quality of program activities and ensure they meet established standards.
- Develop and implement strategies to detect and prevent fraud, including establishing controls and monitoring systems.
- Independently assess existing processes for efficiency, effectiveness, and compliance.
- Collaborate with departments, stakeholders, and external entities on program integrity.
- Conduct advanced investigations into potential fraud, misconduct, or non-compliance and take appropriate corrective actions.
- Maintain accurate documentation and produce regular reports on program-integrity metrics and compliance status.
- Instruct program staff on relevant compliance and integrity matters.
- Manage team performance through timely feedback and formal performance reviews, supporting service delivery, engagement, motivation, and team development.
- Support the Senior Manager - Program Integrity with contract operations and administration, oversee investigative teams' day-to-day activities, and lead targeted/strike force reviews and intelligence targeting.
- Monitor and analyze performance metrics to identify process and procedure improvements.
- Communicate regularly and act as a liaison with government agencies, regulatory bodies, and other external stakeholders.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
