Head of Programme Management

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 corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for underserved communities.

• Owns responsibility for ensuring the optimal performance of the Program Integrity division within enterprise contracts, continuously monitoring and analyzing performance metrics to identify opportunities for improving processes and procedures.
• Assists and supports Senior Manager - Program Integrity in operations and administration of contracts, overseeing the day-to-day activities of investigative teams and leading in targeted/strike force reviews and intelligence targeting.
• Communicates regularly and serves as a liaison with government agencies, regulatory bodies, and other external stakeholders to ensure transparent and compliant company programs.
• Directs teams to monitor and ensure compliance with relevant laws, regulations, and organizational policies, working to prioritize and collaborate on investigations and fraud schemes.
• Identifies and evaluates potential risks to program integrity and develops strategies to mitigate these risks.
• Installs best of class measures to maintain and improve the quality of program activities, ensuring they meet established standards.
• Formulates and implements strategies to detect and prevent fraud within programs, including establishing controls and monitoring systems.
• Conducts advanced investigations into potential instances of fraud, misconduct, or non-compliance; Instructs program staff on relevant compliance and integrity matters to ensure understanding and adherence to policies.
• Manages team performance through regular, timely feedback as well as the formal performance review process to ensure delivery of exceptional services and engagement, motivation, and team development.

Level of Supervision Received:

• Minimum Bachelor's Degree required

Work Experience (can be substituted for education):

• Certified Fraud Examiner or Accredited Healthcare Anti-fraud Investigator preferred

Qlarant is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.