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

State of Maryland; Maryland; Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

State of Maryland's Developmental Disabilities Administration seeks a Program Manager for Program Compliance and Integrity to lead quality, compliance, and program integrity for HCBS waivers and state-funded services in Baltimore, MD.

The role oversees compliance monitoring, evidence reporting, and auditing activities to ensure services meet CMS and state requirements, promoting equity and continuous improvement across the organization.

Qualifications

• Education: Bachelor's or Master's in Healthcare Administration, Public Health, Business, Finance or related field with at least 6 years health/human services admin experience (3 yrs in a supervisory role).
• Master's degree substitutes for one year of general experience; Doctorate substitutes for two years. Additional degree substitutions by year.

Responsibilities

• Lead QA, quality improvement, compliance monitoring, and program integrity activities.
• Oversee efforts to prevent, detect, and address fraud, waste, abuse, and improper payments.
• Establish performance standards, identify systemic risks, oversee corrective actions, and provide technical assistance to strengthen provider and program performance.
• Monitor waiver performance measures and prepare evidence for federally required reports; coordinate audits.
• Coordinate Regional Office Quality Enhancement teams; assist with DDA Waiver Advisory Council duties.

Skills

Risk Management

Data Literacy

Reporting

Education

Bachelor's or Master's in Healthcare Administration / Public Health / Business / Finance

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:

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

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.