State of Massachusetts
Deputy Program Integrity Director
State of Massachusetts, Boston, Massachusetts, us, 02298
State of Massachusetts Deputy Program Integrity Director
Location: Boston, MassachusettsThe Deputy Program Integrity Director is a policy, people, and operational leader within the Program Integrity Unit of MassHealth. The Program Integrity Unit is a highly strategic function within MassHealth that sets the standard for financial stewardship. Program Integrity leads and coordinates efforts related to ensuring Commonwealth resources are utilized appropriately in support of MassHealth members.Under the general direction of the Director of Program Integrity, the Deputy Program Integrity Director is responsible for leading MassHealth’s efforts to control fraud, waste, and abuse (FWA) across the agency’s programs. The Deputy Director has two primary responsibilities: 1) ensuring that Managed Care Organizations who contract with MassHealth are appropriately utilizing state funds, and 2) enabling the operational effectiveness of Program Integrity across all its sub-teams.This position will focus on predicting, detecting, preventing, and deterring inappropriate payments to healthcare providers. The Deputy Director is ultimately accountable for executing successful projects that have meaningful impact on MassHealth members’ lives and/or generate material savings to the Commonwealth.Duties and Responsibilities:Lead program integrity oversight of managed care entities’ controls against fraud, waste, and abuse, including identification and implementation of best practices, reporting compliance, and claims data analysis.Identify new Program Integrity initiatives to drive savings, cost avoidance, and/or revenue.Lead and manage cross-functional teams on baseline projects and new initiatives, including representatives from program teams, policy, strategy, and legal.Build operational excellence, including development, maintenance, and implementation of work plans and standard operating procedures for key program integrity initiatives.Maintain program integrity budget tracker and communicate quarterly status updates across teams to the executive team.Respond to urgent agency, legislative or regulatory priorities as identified.Preferred Qualifications:Excellent analytical and problem-solving skills.Excellent MS Excel and PowerPoint skills.Excellent communication skills.Entrepreneurial mindset; ability to identify opportunities and develop solutions with minimal guidance.Experience analyzing large data sets and/or overseeing analytics teams.Knowledge of CMS and MassHealth regulations.Experience in healthcare strongly preferred.Demonstrated performance in strategic planning and analysis.Minimum Entrance Requirements:Applicants must have at least (A) six (6) years of full-time or equivalent part-time professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration, or clinical management, of which (B) at least two (2) years must have been in a project management, supervisory, or managerial capacity.TO APPLY:
Please upload both Resume and Cover Letter for this position when applying.
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Location: Boston, MassachusettsThe Deputy Program Integrity Director is a policy, people, and operational leader within the Program Integrity Unit of MassHealth. The Program Integrity Unit is a highly strategic function within MassHealth that sets the standard for financial stewardship. Program Integrity leads and coordinates efforts related to ensuring Commonwealth resources are utilized appropriately in support of MassHealth members.Under the general direction of the Director of Program Integrity, the Deputy Program Integrity Director is responsible for leading MassHealth’s efforts to control fraud, waste, and abuse (FWA) across the agency’s programs. The Deputy Director has two primary responsibilities: 1) ensuring that Managed Care Organizations who contract with MassHealth are appropriately utilizing state funds, and 2) enabling the operational effectiveness of Program Integrity across all its sub-teams.This position will focus on predicting, detecting, preventing, and deterring inappropriate payments to healthcare providers. The Deputy Director is ultimately accountable for executing successful projects that have meaningful impact on MassHealth members’ lives and/or generate material savings to the Commonwealth.Duties and Responsibilities:Lead program integrity oversight of managed care entities’ controls against fraud, waste, and abuse, including identification and implementation of best practices, reporting compliance, and claims data analysis.Identify new Program Integrity initiatives to drive savings, cost avoidance, and/or revenue.Lead and manage cross-functional teams on baseline projects and new initiatives, including representatives from program teams, policy, strategy, and legal.Build operational excellence, including development, maintenance, and implementation of work plans and standard operating procedures for key program integrity initiatives.Maintain program integrity budget tracker and communicate quarterly status updates across teams to the executive team.Respond to urgent agency, legislative or regulatory priorities as identified.Preferred Qualifications:Excellent analytical and problem-solving skills.Excellent MS Excel and PowerPoint skills.Excellent communication skills.Entrepreneurial mindset; ability to identify opportunities and develop solutions with minimal guidance.Experience analyzing large data sets and/or overseeing analytics teams.Knowledge of CMS and MassHealth regulations.Experience in healthcare strongly preferred.Demonstrated performance in strategic planning and analysis.Minimum Entrance Requirements:Applicants must have at least (A) six (6) years of full-time or equivalent part-time professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration, or clinical management, of which (B) at least two (2) years must have been in a project management, supervisory, or managerial capacity.TO APPLY:
Please upload both Resume and Cover Letter for this position when applying.
#J-18808-Ljbffr