Senior Director, Program Integrity

🕒 Abril 23

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $145.000 - $160.000 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Diretor

🦅 Patrocina Visto H1B

Esta empresa já patrocinou vistos H1B no passado.

Candidatar-se

Encontrar Vagas Remotas Similares

Receber Emails de Vagas Remotas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

Public Partnerships | PPL

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

⚕️ Seguro de Saúde

🤝 B2B

Healthcare Insurance • B2B

A Public Partnerships | PPL é uma fornecedora de serviços de gestão financeira e administrativa que possibilitam o cuidado de longo prazo autoproposto pelo Medicaid. A empresa ajuda os participantes elegíveis do Medicaid a contratar e gerenciar cuidadores (incluindo familiares ou amigos), lida com a folha de pagamento, pagamentos, documentos fiscais e de conformidade, e oferece ferramentas online e suporte para participantes, cuidadores e administradores de programas. A PPL faz parceria com agências estaduais do Medicaid e organizações de cuidados gerenciados para administrar programas de cuidado autoproposto em vários estados, com o objetivo de simplificar a administração do programa e manter as pessoas em suas casas.

Descrição

• Provide strategic and operational leadership over the organization’s enterprise‑wide fraud, waste, and abuse (FWA) program • Ensure regulatory compliance, risk mitigation, and program effectiveness across all states • Serve as the primary senior liaison with regulatory and law enforcement agencies • Oversee fraud detection, investigation, audit readiness, and corrective action management • Establish governance frameworks, drive data‑informed integrity initiatives, standardize processes, and lead continuous improvement efforts • Map, maintain, and continuously update a comprehensive inventory of all relevant state program integrity agencies • Serve as the primary point of contact with regulators and establish strong relationships with regulatory partners • Design and implement an enterprise-wide program integrity framework • Develop and maintain a centralized fraud risk register • Oversee fraud investigation and auditing, ensuring effective intake, investigation, and resolution of fraud cases • Partner with data/analytics teams to develop predictive fraud detection methodologies • Lead the development and execution of fraud prevention initiatives and drive continuous improvement

🎯 Requisitos

• Excellent knowledge of relevant laws, regulations and industry standards • CDPAP and Medicaid experience • Experience managing relationships with MFCUs and state oversight agencies • Ability to communicate complex compliance issues clearly and effectively • Expert in FWA and ANE investigative processes • Strong analytical, interpersonal, and organizational skills • Proficiency in Microsoft Office technology; comfortable learning new systems and communicating system design needs • Demonstrated competence in reviewing contracts and other legal and regulatory documents • Strong attention to detail and process improvement • Excellent written and oral communication skills • Ability to negotiate with partners for prioritization and resource allocation • Comfortable with healthy conflict • Skilled at developing and maintaining accountability within corporations • Demonstrated ability to build highly effective teams and manage staff • Strong work ethic and ability to prioritize tasks in a fast-paced, dynamic environment • Bachelor’s degree preferred; Substantial professional experience may be considered in lieu of a formal degree.

🏖️ Benefícios

• 401k Retirement Plan • Medical, Dental and Vision insurance on first day of employment • Generous Paid Time Off • Employee Assistance Program and more