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Oregon Department of Human Services
Oregon Department of Human Services
ConsultingFood & BeverageHealthcare
The Oregon Department of Human Services is a state government agency supporting the health, safety, and well-being of people across Oregon. Its work spans child welfare, self-sufficiency services, and support for older adults and people with disabilities. The department collaborates with state agencies and community partners to deliver programs that help individuals, families, and communities meet essential needs. Its large public-service workforce contributes to the administration and delivery of social and human services throughout the state.
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Program Integrity Administrator – Medicaid Compliance and Fraud, Waste, and Abuse

Lead Oregon Health Authority’s statewide Medicaid program integrity, fraud, waste, abuse, compliance, and audit functions. Direct multidisciplinary teams, partnerships, budgets, and strategy across a complex public healthcare operation.

USUnited StatesOROregon
$9,604 – $14,856 / month
HybridFull-timeMiddleSeniorEnglish RequiredAdministration

Description

  • Lead statewide Medicaid program integrity, fraud, waste, abuse, and compliance operations for OHA
  • Set priorities, establish policies and performance goals, and align OPI operations with OHA’s mission and applicable federal and state requirements
  • Direct a multidisciplinary team covering investigations, financial and compliance audits, data analytics, provider oversight, and Medicaid program integrity
  • Monitor emerging risks and trends while strengthening detection and investigation methods
  • Apply data and operational insights to improve program integrity outcomes
  • Advise OHA leadership on relevant policy matters
  • Develop and sustain partnerships throughout Oregon and with federal stakeholders
  • Act as OHA’s principal liaison to CMS, federal oversight bodies, the Oregon Department of Justice Medicaid Fraud Control Unit, the Secretary of State, state agencies, contractors, providers, and community and industry partners
  • Represent OHA on committees, task forces, and technical advisory groups
  • Deliver consultation, education, and technical assistance on Medicaid compliance and program integrity
  • Oversee OPI budgets, contracts, workforce planning, strategic planning, and performance management
  • Manage a complex program integrity portfolio within OHA’s approximately $21 billion annual operation
  • Make significant decisions independently within the scope of the role
  • Report directly to the Chief Financial Officer

Requirements

  • At least five years of management experience, or two years of management experience combined with a bachelor’s degree in a related field
  • Experience leading or managing Medicaid program integrity, regulatory compliance, fraud, waste, abuse, audit, investigation, or oversight functions
  • Experience setting strategic direction, establishing priorities, defining performance goals, and leading complex programs or multidisciplinary teams
  • Experience overseeing or conducting complex investigations, audits, risk assessments, data analysis, or work addressing fraud, waste, abuse, overutilization, or compliance issues
  • Experience working with federal, state, or local regulators, oversight bodies, law enforcement organizations, or government entities
  • Experience using audits, research, analytics, performance metrics, financial data, or other information to identify trends, assess risk, improve operations, and guide policy or management decisions
  • Ability to explain complex regulatory, financial, operational, or compliance matters to executive leaders
  • Ability to establish effective relationships with varied internal and external stakeholders
  • Employment is contingent on completing a criminal records check that meets OHA criteria
  • Complete I-9 documentation and verify authorization to work in the United States within three days of hire
  • This position does not offer visa sponsorship
  • Submit a resume and complete all required supplemental questions; a bachelor’s degree is required and a master’s degree is preferred.
  • benefits?

Benefits

  • Access to low-cost medical, vision, and dental coverage for you and your family
  • Optional life insurance, disability insurance, deferred compensation, and health and childcare flexible spending account programs
  • 11 paid holidays
  • Three personal days
  • Monthly sick leave accrual
  • Vacation accrual beginning at eight hours per month
  • Possible eligibility for the Public Service Loan Forgiveness Program
  • Retirement benefits through PERS or the Oregon Public Service Retirement Plan
  • Professional training and development opportunities
  • Hybrid and remote work flexibility
  • ADA accommodations, including alternative material formats or language support, are available

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