Program Integrity Manager, Medicaid & SIU Compliance
Overview
Own and drive program integrity initiatives at scale within the New Jersey Medicaid Health Plan. You will partner with Compliance, Legal, Analytics, and Operations to ensure regulatory and contractual obligations are met while advancing fraud, waste, and abuse prevention. Lead cross-functional projects, influence stakeholders, and deliver operational improvements from concept through implementation. This role offers a hybrid work environment and exposure to enterprise-wide program integrity efforts.
What You'll Do5
- 1Lead cross-functional program integrity initiatives from concept through implementation.
- 2Coordinate regulatory reporting, audits, and oversight activities with internal and external stakeholders to demonstrate compliance.
- 3Drive process improvements in FWA prevention, claims operations, and payment integrity across multiple workstreams.
- 4Facilitate meetings and workgroups with leadership to gain alignment and buy-in for strategic initiatives.
- 5Present complex findings to leadership and diverse audiences to influence decisions and priorities.
Requirements5
- 15+ years in Program Integrity, Payment Integrity, SIU, Healthcare Compliance, FWA, or related field in leadership or project lead roles.
- 2Knowledge of healthcare regulatory and compliance requirements.
- 3Strong analytical, organizational, communication, and problem-solving skills.
- 4Experience leading projects, meetings, and cross-functional teams with external partners.
- 5Bachelor's degree or equivalent experience.
Salary Insight
$54 - $146k per year
Location
Required Skills
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