Program Manager, Program Compliance And Integrity

State of Maryland•Baltimore City, MD

5d•Hybrid

About The Position

The Program Manager for Program Compliance and Integrity provides leadership and oversight for the Developmental Disabilities Administration's (DDA) Medicaid Home and Community-Based Services (HCBS) waiver program and state-funded services. This position leads the development, implementation, and evaluation of DDA’s quality, compliance, and program integrity framework to ensure services are delivered in accordance with federal and State requirements. This position promotes a culture of compliance, accountability, equity, and continuous improvement across the organization. The position oversees quality assurance, quality improvement, compliance monitoring, and program integrity activities, including efforts to prevent, detect, and address fraud, waste, abuse, and improper payments. Responsibilities include establishing performance standards and outcomes, identifying systemic risks, overseeing corrective actions, and providing technical assistance to strengthen provider and program performance. The position ensures compliance with CMS HCBS waiver assurances and federal quality requirements. Oversees evidence collection, performance measure reporting, remediation activities, and federally required reporting necessary to maintain waiver approval and federal funding. This position serves as DDA’s lead for CMS waiver assurance and HCBS program integrity requirements, ensuring compliance with federal regulations related to participant health and welfare, provider qualifications, incident management, financial accountability, and person-centered service delivery. This position is responsible for monitoring and reporting waiver performance measures, preparing federally required evidence reports, coordinating audit and oversight activities, and leading quality improvement initiatives. The position coordinates and leads Regional Office Quality Enhancement teams, oversees Office of Health Care Quality performance measures, and assists with administrative duties for the DDA Waiver Advisory Council.

Requirements

Bachelor's or Master's degree in Healthcare Administration, Public Health, Business, Finance or related field from an accredited college or university.
Six years of health or human services administrative or professional experience.
Three years of supervisory or managerial level experience.
At least two years of work experience handling fraud, waste and abuse matters.

Nice To Haves

Proven experience conducting risk assessments, compliance reviews, and program integrity activities.
Ability to analyze large sets of financial or programmatic data to identify aberrant billing practices, anomalies, and risk indicators.
Strong written and verbal skills for developing policies, guidance, and training materials, as well as briefing senior stakeholders.

Responsibilities

Leads the development, implementation, and evaluation of DDA’s quality, compliance, and program integrity framework.
Promotes a culture of compliance, accountability, equity, and continuous improvement.
Oversees quality assurance, quality improvement, compliance monitoring, and program integrity activities.
Establishes performance standards and outcomes.
Identifies systemic risks and oversees corrective actions.
Provides technical assistance to strengthen provider and program performance.
Ensures compliance with CMS HCBS waiver assurances and federal quality requirements.
Oversees evidence collection, performance measure reporting, remediation activities, and federally required reporting.
Serves as DDA’s lead for CMS waiver assurance and HCBS program integrity requirements.
Monitors and reports waiver performance measures.
Prepares federally required evidence reports.
Coordinates audit and oversight activities.
Leads quality improvement initiatives.
Coordinates and leads Regional Office Quality Enhancement teams.
Oversees Office of Health Care Quality performance measures.
Assists with administrative duties for the DDA Waiver Advisory Council.