PROGRAM MANAGER, PROGRAM COMPLIANCE AND INTEGRITY ((Program Manager II))

State of Maryland; Baltimore, Northern (MD, KY); Hybrid; USD 95,000 - 125,000; Full time

Job summary

State of Maryland is seeking a Program Manager for Program Compliance and Integrity within the Developmental Disabilities Administration in Baltimore, MD. The role leads the framework for quality, compliance and program integrity for the HCBS waiver and state-funded services.

Responsibilities include QA/QI oversight, remediation, audits, and reporting; coordinating Regional Office QA teams and supporting the Waiver Advisory Council.

Qualifications

• Bachelor's or Master's degree in Healthcare Administration, Public Health, Business, Finance or related field from an accredited college or university and six years of health or human services administrative or professional experience, including three years at a supervisory or managerial level.
• Two years of work experience handling fraud, waste and abuse matters. Master’s substitutes for one year of general experience; Doctorate substitutes for two years.

Responsibilities

• Provide leadership and oversight for quality, compliance, and program integrity across DDA's HCBS waiver program and state-funded services.
• Oversee QA/QI, compliance monitoring, and efforts to prevent, detect, and address fraud, waste, abuse, and improper payments.
• Ensure CMS HCBS waiver assurances and federal quality requirements; manage evidence collection, performance reporting, and federally required reporting.
• Coordinate and lead Regional Office Quality Enhancement teams and assist with administrative duties for the DDA Waiver Advisory Council.

Skills

Risk management

Data literacy

Reporting

Education

Bachelor's or Master's in Healthcare Administration/Public Health/Business/Finance (or related field)

Job description

GRADE

STD0020

LOCATION OF POSITION

MDH Developmental Disabilities Administration, Baltimore MD

MAIN PURPOSE OF JOB

The Program Manager for Program Compliance and Integrity provides leadership and oversight for the Developmental Disabilities Administration's (DDA) Medicaid Home and Community-Based Services (HCBS) waiver program and state-funded services. This position leads the development, implementation, and evaluation of DDA’s quality, compliance, and program integrity framework to ensure services are delivered in accordance with federal and State requirements. This position promotes a culture of compliance, accountability, equity, and continuous improvement across the organization.

The position oversees quality assurance, quality improvement, compliance monitoring, and program integrity activities, including efforts to prevent, detect, and address fraud, waste, abuse, and improper payments. Responsibilities include establishing performance standards and outcomes, identifying systemic risks, overseeing corrective actions, and providing technical assistance to strengthen provider and program performance.

The position ensures compliance with CMS HCBS waiver assurances and federal quality requirements. Oversees evidence collection, performance measure reporting, remediation activities, and federally required reporting necessary to maintain waiver approval and federal funding.

Measure:

• Waiver assurance reports submitted timely and accurately.
• Evidence reports meet CMS requirements.
• Remediation activities are completed according to approved waiver methodologies.
• Federal and State audit requests are addressed within required timeframes.

This position serves as DDA’s lead for CMS waiver assurance and HCBS program integrity requirements, ensuring compliance with federal regulations related to participant health and welfare, provider qualifications, incident management, financial accountability, and person-centered service delivery.

This position is responsible for monitoring and reporting waiver performance measures, preparing federally required evidence reports, coordinating audit and oversight activities, and leading quality improvement initiatives. The position coordinates and leads Regional Office Quality Enhancement teams, oversees Office of Health Care Quality performance measures, and assists with administrative duties for the DDA Waiver Advisory Council.

This position is subject to hybrid working conditions for the purpose of teleworking at a minimum of two (2) days per week.

MINIMUM QUALIFICATIONS

Qualified candidate must possess a Bachelor's or Master's degree in Healthcare Administration, Public Health, Business, Finance or related field from an accredited college or university and six years of health or human services administrative or professional experience, including three years at a supervisory or managerial level. Qualified candidates must also possess at least two years of work experience handling fraud, waste and abuse matters.

A Master's degree from an accredited college or university substitutes for one year of the general experience and a Doctorate substitutes for two years of the general experience. Additional experience substitutes for the college degree on a year-for-year basis.

DESIRED OR PREFERRED QUALIFICATIONS

Desired candidates should possess experience in the following:

• 1. Risk Management: Proven experience conducting risk assessments, compliance reviews, and program integrity activities.
• 2. Data Literacy: Ability to analyze large sets of financial or programmatic data to identify aberrant billing practices, anomalies, and risk indicators.
• 3. Reporting: Strong written and verbal skills for developing policies, guidance, and training materials, as well as briefing senior stakeholders.

SELECTION PROCESS

This is a Management Service position and serves at the pleasure of the Appointing Authority. A resume must be uploaded to the application. Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment and may be requested prior to interview. Complete applications must be submitted by the closing date. Information submitted after this date will not be added. Incorrect application forms will not be accepted. Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.