Program Integrity Manager (HCA/MAD #10118528)

New Mexico Department of Justice; Albuquerque (NM); Sur place; USD 70 000 - 110 000; Plein temps

Résumé du poste

The Health Care Authority is seeking a Program Integrity Manager to monitor compliance with federal and state Medicaid regulations, coordinate reporting to CMS, OIG, HHS and GAO, and oversee audits. The role maintains documentation and updates compliance plans and procedures to reflect current rules and risks.

Ideal candidates will have Medicaid/public-sector experience, ability to coordinate across eligibility, payments and policy teams, and a proven track record in integrity risk mitigation

Qualifications

• Experience managing program integrity, compliance, or oversight within Medicaid or public-sector programs.
• Ability to coordinate across eligibility, payments and policy teams.
• Experience developing and implementing integrity controls and procedures.

Responsabilités

• Monitor compliance with CFR, NM Administrative Code and Medicaid regulations.
• Coordinate reporting to CMS, OIG, HHS and GAO; coordinate audits.
• Maintain audit/training/compliance documentation and update plans and procedures.

Connaissances

Program integrity management

Compliance oversight

Cross-functional coordination

Reporting & documentation

Formation

Bachelor's degree in a relevant field

Description du poste

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Job Title Program Integrity Manager (HCA/MAD #10118528)

For more Job Requirements & Classification Description:

Interviews are anticipated to be conducted within two weeks of closing date.

This job posting may be used to fill multiple vacancies.

The Health Care Authority (HCA) participates in E-Verify and will verify employment eligibility upon hire.

Our Vision

• Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system.

Our Mission

• We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

Our Goals

• Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce.
• Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives.
• Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information.
• Build the best team in state government by supporting employees continuous growth and wellness.

Why does the job exist?

The Program Integrity Manager will:

• Monitor compliance with Code of Federal Regulations, New Mexico Administrative Code and other Medicaid related regulations;
• Coordinate reporting to oversight agencies such as Centers for Medicare & Medicaid Services (CMS), Office of Inspector General (OIG), U.S. Department of Health and Human Services (HHS), U.S. Governmental Accountability Office (GAO);
• Coordinate audits and monitor activities;
• Maintain documentation of audits, training and compliance activities;
• Draft, review and update compliance plans, policies and procedures.

How does it get done?

The Program Integrity Manager is responsible for:

• Managing the day-to-day coordination of Program Integrity activities associated with House Representative Bill One (HR1) implementation;
• Developing and managing dashboards for scheduled and ad hoc audits, surveys and reports;
• Coordinating the completion, executive review and submission of response documents to federal and state oversight entities;
• Developing and tracking Program Integrity procedures;
• Identifying Program Integrity risks and supporting implementation of mitigation strategies to protect Medicaid resources.

Who are the customers?

• Internal stakeholders across Health Care Authority (HCA) and Medical Assistance Division (MAD), including program integrity staff, eligibility and payments teams, policy and systems partners, and leadership involved in oversight activities.

Ideal Candidate

The Ideal Candidate has experience:

• Managing program integrity, compliance, or oversight activities within Medicaid or public-sector programs;
• Coordinating integrity-related work across eligibility, payments, and policy teams;
• Supporting development and implementation of integrity procedures and controls;
• Tracking performance indicators and compliance outcomes;
• Preparing reports and documentation for oversight and leadership review;
• Identifying and supporting resolution of integrity risks or issues
• Working within regulated or compliance-driven environments
• Managing multiple priorities in support of complex program initiatives.

Bachelor's Degree in a relevant field of study from an accredited college or university and two (2) years of professional level experience with a tactical impact directly related to the purpose of the position defined by the agency at the time of recruitment. Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling six (6) years may substitute for the required education and experience.

Employment Requirements

Must possess and maintain a valid Driver's License.
Must obtain a Defensive Driving Certification.

Working Conditions

Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT), extensive personal computer and phone usage with extended periods of sitting.

Supplemental Information

For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.

Bargaining Unit Position

This position is covered by a collective bargaining agreement and all terms/conditions of that agreement apply and must be adhered to.