Program Manager Jobs

About The Position

Requirements

• Bachelor's degree plus 15 years of relevant experience, or master's degree plus 12 years of relevant experience.
• Significant experience supporting CMS, CMCS, state Medicaid agencies, Medicaid managed care organizations, or related healthcare organizations.
• Deep expertise in Medicaid financing, payment methodologies, federal claiming requirements, and financial oversight.
• Experience with PERM, improper payment measurement, payment integrity, claims compliance, and program integrity initiatives.
• Knowledge of Medicaid claims adjudication, payment controls, and oversight at the state, federal, health plan, or contractor level.
• Experience with fraud, waste, and abuse, including risk management, auditing, monitoring, investigations, and compliance oversight.
• Expertise in HCBS financing payment methodologies, electronic visit verification, and rate-setting.
• Knowledge of Section 1115 demonstrations, financing mechanisms, and budget neutrality requirements.
• Understanding of how Medicaid eligibility, coverage, and benefits affect claims, payment, and financial oversight.
• Experience developing solutions that leverage analytics, automation, SaaS platforms, or AI for Medicaid financial and program oversight.
• Demonstrated success building client relationships, influencing senior decision makers, and contributing to business growth.
• Ability to communicate complex technical, financial, policy, and regulatory issues to diverse audiences.
• Demonstrated success leading client relationships, business development efforts, and multidisciplinary teams.
• Experience shaping and delivering complex Medicaid financing, payment integrity, or program integrity initiatives.

Nice To Haves

• Prior experience within CMS Center for Medicaid and CHIP Services (CMCS), particularly the Financial Management Group (FMG), CMS Center for Program Integrity, or the U.S. Department of Health and Human Services Office of Inspector General.
• Senior leadership experience within a state Medicaid agency, Medicaid managed care organization, or organization supporting Medicaid financial management or program integrity.
• Existing relationships with CMS, CMCS, state Medicaid agencies, or related stakeholders.
• Experience applying advanced analytics, predictive modeling, machine learning, or AI to identify payment risk, improve payment accuracy, and strengthen program oversight.

Responsibilities

• Serve as a strategic advisor to CMS, state Medicaid agencies, and other healthcare stakeholders.
• Build and maintain trusted executive-level client relationships.
• Identify, shape, and pursue strategic growth opportunities aligned with client priorities and Abt's capabilities.
• Lead client engagement activities, account planning, and on-contract growth activities.
• Represent Abt at conferences, industry forums, and client meetings as a thought leader.
• Advise clients on Medicaid financing structures, federal claiming requirements, provider payment methodologies, HCBS rate setting and oversight, state financial management, and managed care oversight.
• Advise on Section 1115 financing, budget neutrality, expenditure authorities, and the financing implications of evolving federal demonstration policy, as needed.
• Connect eligibility, coverage, and benefit policy to claims adjudication, payment operations, and financial oversight to identify financial and program integrity risks.
• Provide expertise in PERM, improper payment prevention, claims compliance, payment risk identification, pre- and post-payment reviews, audits, corrective action, and payment accuracy strategies.
• Partner with policy experts, technologists, and data scientists to develop Medicaid payment integrity solutions.
• Advise on analytics, predictive modeling, anomaly detection, and AI to identify payment risks and prevent improper payments, fraud, waste, and abuse.
• Support development of scalable tools, accelerators, and AI-enabled solutions for Medicaid oversight and program integrity.
• Promote proactive, data-driven approaches to identify and prevent payment errors.
• Lead or support capture, proposal development, and solution design for Medicaid finance, program integrity, and analytics opportunities.
• Identify, develop, and manage a Medicaid sales pipeline aligned with Health market priorities and Abt's growth strategy.
• Translate complex policy, financial, and operational challenges into differentiated client solutions and value propositions.
• Collaborate across business development, delivery, digital, and advisory teams to develop integrated solutions and support growth.
• Contribute to white papers, publications, conference presentations, and other market-facing content.
• Mentor staff and build organizational expertise in Medicaid finance, payment integrity, and related policy and operational areas.
• Foster collaboration across policy, research, implementation, digital, and analytics teams.

Benefits

• Comprehensive employee benefits.
• Flexible schedules.
• Professional development.
• Market-competitive salaries.