Head of Programme Management

Qlarant; New Mexico; On-site; USD 90,000 - 130,000; Full time

Job summary

Qlarant is seeking a Program Integrity leader to oversee the division within enterprise contracts in our not-for-profit organization. The role emphasizes efficiency, regulatory compliance, and strong collaboration with public agencies to prevent fraud and improve program outcomes.

You will coach investigation teams, implement controls, and drive performance through structured reviews. This position requires a Bachelor's degree and professional fraud investigation credentials for preferred

Qualifications

• Minimum Bachelor's Degree required.
• Professional certification (CFE or Accredited Healthcare Anti-fraud Investigator) preferred.
• Experience leading program integrity investigations and fraud risk mitigation.

Responsibilities

• Own responsibility for ensuring the optimal performance of the Program Integrity division within enterprise contracts.
• Assist and support Senior Manager - Program Integrity in operations and administration of contracts.
• Communicate regularly and liaise with government agencies, regulatory bodies, and external stakeholders.
• Direct teams to monitor and ensure compliance with laws, regulations, and policies.
• Identify and evaluate potential risks to program integrity and develop mitigation strategies.
• Install best-in-class measures to maintain and improve program activities.
• Formulate strategies to detect and prevent fraud within programs, including controls and monitoring.
• Conduct advanced investigations into potential fraud or non-compliance; instruct staff on compliance matters.
• Manage team performance through regular feedback and formal reviews.

Skills

Investigations leadership

Compliance oversight

Stakeholder liaison

Fraud detection

Education

Bachelor's degree

Certified Fraud Examiner (CFE) or Accredited Healthcare Anti-fraud Investigator (preferred)

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.