Senior Associate Director, Provider Compliance (Hybrid)

Health & Human Services; North Carolina; Hybrid; USD 76,000 - 148,000; Full time

Job summary

The North Carolina Department of Health and Human Services (DHHS) seeks a senior program manager to lead the Office of Compliance and Program Integrity. The role focuses on establishing and executing provider audits, investigations, and oversight across NC Medicaid contracted plans, ensuring compliance with CMS rules and state regulations.

Leadership, collaboration with analytics, and staff development are key responsibilities.

Qualifications

• Experience in leading and overseeing fraud, waste, and abuse detection in Medicaid or similar programs.
• Experience supervising staff, managing contractors, and vendor relationships.
• Strong data analysis and investigative planning skills.

Responsibilities

• Lead development of policies and procedures for provider audits and investigations.
• Oversee oversight of Special Investigations Units within managed care plans.
• Manage vendor audits and coordinate with other leaders for joint investigations.
• Enforce provider policies and corrective actions for identified violations.
• Ensure alignment with CMS rules and state requirements.
• supervise personnel, set goals, and support staff development.

Skills

FWA detection

Leadership

Data analysis

Policy compliance

Stakeholder collaboration

Project oversight

Tools

Microsoft Teams

Outlook

Excel

Word

Job description

The North Carolina Department of Health and Human Services (DHHS) seeks a senior program manager to lead the Office of Compliance and Program Integrity. The role focuses on establishing and executing provider audits, investigations, and oversight across NC Medicaid contracted plans, ensuring compliance with CMS rules and state regulations.

Leadership, collaboration with analytics, and staff development are key responsibilities.