Hybrid-Remote Provider Compliance Lead

Arts In Wilmington; North Carolina; Hybrid; USD 101,000 - 108,000; Full time

Benefits offered by this job

Hybrid schedule

Job summary

The North Carolina Department of Health and Human Services seeks a seasoned leader to oversee the Office of Compliance and Program Integrity's provider audits and investigations. You will guide policies, coordinate with Medicaid investigations, and ensure compliance with CMS and state rules while driving program performance.

You will manage a large team, collaborate with legal, analytics and health plans, and engage in high‑priority cases requiring cross‑agency partnerships; this is a hybrid

Qualifications

• Deep expertise in detecting and preventing fraud, waste, and abuse (FWA) within Medicaid and managed care.
• Ability to translate data insights into actionable investigative strategies.
• Experience leading complex investigations and coordinating with law enforcement and providers.
• Strong leadership, vendor management and cross‑functional collaboration skills.

Responsibilities

• Lead development and execution of policies for provider audits and investigations.
• Oversee the monitoring of contracted managed care plans' Special Investigations Units.
• Coordinate with OCPI Analytics, MID and counsel for investigations and compliance actions.
• Measure performance and drive improvements in the provider compliance program.
• Recruit, supervise and develop staff; manage performance and goals.

Skills

Fraud detection & prevention

misconduct investigations

Leadership of large teams

Vendor management

Interagency collaboration

Microsoft Office proficiency

Job description

The North Carolina Department of Health and Human Services seeks a seasoned leader to oversee the Office of Compliance and Program Integrity's provider audits and investigations. You will guide policies, coordinate with Medicaid investigations, and ensure compliance with CMS and state rules while driving program performance.

You will manage a large team, collaborate with legal, analytics and health plans, and engage in high‑priority cases requiring cross‑agency partnerships; this is a hybrid