Director, Medicare Program Integrity Operations
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Job Description
Senior leader at Integrity Management Services overseeing federal healthcare program compliance and performance improvement. Leading teams and ensuring high-quality execution and regulatory compliance.
Responsibilities:
- Provide executive oversight and direction for program operations, ensuring performance aligns with contractual requirements, government guidance, and quality standards.
- Serve as a senior interface with government stakeholders, supporting governance, performance reviews, issue resolution, and risk management.
- Lead integrated teams and subcontractor partners to deliver efficient, compliant, and timely program outcomes.
- Oversee healthcare program integrity activities, including data-driven analysis, audits, oversight activities, and stakeholder communications.
- Ensure high-quality delivery of program outputs such as analytic reports, alerts, and external communications.
- Provide leadership for audit planning, execution, documentation, and corrective action processes.
- Oversee operational workflows for correspondence management, issue tracking, and responsiveness to external stakeholders.
- Lead coordination with related federal contractors and oversight entities to support aligned program execution and avoid duplication of effort.
- Support transition and implementation activities for new or expanding federal programs, ensuring continuity of operations.
- Ensure compliance with federal security, privacy, training, and records management requirements.
Requirements:
- Bachelor’s degree required.
- 10+ years of experience in healthcare program operations, program integrity, compliance, auditing, or federal health programs.
- 3+ years of experience leading complex teams and managing large-scale, time-sensitive program operations.
- Strong knowledge of Medicare-related programs (Parts A, B C & D), healthcare compliance, or payment integrity preferred.
- Experience with managed care auditing.
- Experience working with federal clients or contractors strongly preferred.
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