Medicaid Program Integrity Lead - Hybrid/Remote

State of Oregon; Oregon; Hybrid; USD 1,286,000 - 1,990,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

Competitive retirement benefits

Paid time off & holidays

Job summary

Oregon Health Authority seeks an experienced Administrator for Program Integrity to lead statewide Medicaid integrity, fraud detection, audits, and investigations. You will direct a multidisciplinary team, set strategic priorities, and ensure alignment with federal/state requirements while safeguarding Medicaid funds and promoting health equity.

The role emphasizes leadership, data-driven decision making, and collaboration with CMS, DOJ, and state agencies to strengthen program integrity and

Qualifications

• Five years of management experience; OR two years of management experience and a bachelor’s degree in a related field.
• Demonstrated experience leading Medicaid program integrity, regulatory compliance, FWA, audit, investigation, or oversight activities.
• Strategic direction, priorities, and performance objectives for complex programs or multidisciplinary teams.
• Experience working with federal/state regulatory, oversight, law enforcement, or government entities on compliance or audit matters.
• Data analytics or performance measures to identify trends, assess risk, and improve operations.

Responsibilities

• Provide strategic leadership for statewide program integrity, fraud, waste, and abuse (FWA) and Medicaid compliance operations.
• Lead a multidisciplinary team responsible for investigations, audits, data analytics, provider oversight, and program integrity activities.
• Set priorities, develop policies, and ensure budget, contracts, staffing, and performance management align with OHA goals.
• Build partnerships with CMS, federal agencies, state regulators, and healthcare stakeholders.
• Represent OHA in committees and advisory groups and provide guidance on Medicaid compliance and program integrity.

Skills

Medicaid program integrity

Regulatory compliance

Fraud, waste & abuse investigations

Data-driven management

Executive communication

Stakeholder engagement

Education

Bachelor's degree in related field

Job description

Oregon Health Authority seeks an experienced Administrator for Program Integrity to lead statewide Medicaid integrity, fraud detection, audits, and investigations. You will direct a multidisciplinary team, set strategic priorities, and ensure alignment with federal/state requirements while safeguarding Medicaid funds and promoting health equity.

The role emphasizes leadership, data-driven decision making, and collaboration with CMS, DOJ, and state agencies to strengthen program integrity and