Head of Program Integrity & Investigations

Qlarant; Clifton (TX); On-site; USD 90,000 - 140,000; Full time

Job summary

Qlarant is a not-for-profit organization focused on health care and human services programs, including population health, utilization review, and quality assurance. The role oversees the Program Integrity division, analyzing performance metrics and directing investigations to prevent fraud and non-compliance across contracts.

The position requires a minimum Bachelor's Degree, with Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred.

Qualifications

• Bachelor's degree required for eligibility.
• Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred.

Responsibilities

• Owns responsibility for ensuring optimal performance of the Program Integrity division and monitors performance metrics.
• Assists Senior Manager - Program Integrity in operations and contract administration, overseeing investigation teams.
• Communicates with government agencies, regulators, and external stakeholders to ensure compliant programs.
• Directs teams to monitor compliance with laws and organizational policies, prioritizing investigations and fraud schemes.
• Identifies and mitigates risks to program integrity and develops improvement strategies.
• Implements measures to maintain and improve program activities against standards.
• Conducts advanced investigations into fraud, misconduct, or non-compliance; trains staff on relevant policies.
• Manages team performance with feedback and performance reviews to ensure high-quality service.

Skills

Team leadership

Regulatory compliance

Stakeholder communication

Education

Bachelor's Degree

Certified Fraud Examiner

Job description

Qlarant is a not-for-profit organization focused on health care and human services programs, including population health, utilization review, and quality assurance. The role oversees the Program Integrity division, analyzing performance metrics and directing investigations to prevent fraud and non-compliance across contracts.

The position requires a minimum Bachelor's Degree, with Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred.