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Public Partnerships LLC supports individuals with disabilities or chronic illnesses and aging adults, to remain in their homes and communities and “self” direct their own long-term home care. Our role as the nation’s largest and most experienced Financial Management Service provider is to assist those eligible Medicaid recipients to choose and pay for their own support workers and services within their state-approved personalized budget. We are appointed by states and managed healthcare organizations to better serve more of their residents and members requiring long-term care and ensure the efficient use of taxpayer funded services.
Our culture attracts and rewards people who are results-oriented and strive to exceed customer expectations. We desire motivated candidates who are excited to join our fast-paced, entrepreneurial environment, and who want to make a difference in helping transform the lives of the consumers we serve. (learn more at www.pplfirst.com).
The Senior Director, Program Integrity provides strategic and operational leadership over the organization’s enterprise‑wide fraud, waste, and abuse (FWA) program, ensuring regulatory compliance, risk mitigation, and program effectiveness across all states. Reporting to the Vice President, Compliance, this role serves as the primary senior liaison with regulatory and law enforcement agencies, including OMIG and MFCUs, and oversees fraud detection, investigation, audit readiness, and corrective action management. The Senior Director establishes governance frameworks, drives data‑informed integrity initiatives, standardizes processes across markets and health plan partners, and leads continuous improvement efforts to identify emerging risks, strengthen controls, and promote a culture of accountability and compliance.
Duties & Responsibilities:
Regulatory & External Relationship Management
Map, maintain, and continuously update a comprehensive inventory of all relevant state program integrity agencies, including MFCUs and state Medicaid integrity units
Serve as the primary point of contact with regulators, including OMIG, MFCUs, and other law enforcement and oversight entities
Establish and maintain strong, credible relationships with regulatory partners to support collaboration, transparency, and trust
Collaborate with Health Plans in fraud, waste and abuse investigation and referral processes.
Oversee and standardize fraud, waste, and abuse referral processes across all states, ensuring timeliness, completeness, and regulatory compliance
Monitor evolving regulatory expectations and ensure program alignment with federal and state requirements
Program Integrity Strategy & Governance
Design and implement an enterprise-wide program integrity framework aligned with organizational risk, regulatory expectations, and industry best practices
Develop and maintain a centralized fraud risk register, including risk identification, scoring, mitigation strategies, and ownership
Establish governance structures for fraud oversight, including reporting to executive leadership and compliance committees
Catalogue and continuously update fraud prevention and detection best practices across the organization
Fraud Detection, Investigation & Oversight
Oversee fraud investigation and auditing
Ensure effective intake, triage, investigation, and resolution of suspected fraud, waste, and abuse cases
Provide strategic direction and oversight for complex, high-risk investigations
Ensure proper documentation, case management, and audit readiness
Monitor and ensure execution of corrective action plans (CAPs) resulting from investigations, audits, and regulatory findings
Analytics, Reporting & Performance Measurement
Oversee the design, implementation, and continuous enhancement of program integrity dashboards and reporting tools
Partner with data/analytics teams to develop predictive and retrospective fraud detection methodologies
Establish KPIs and performance metrics for fraud detection, investigation efficiency, and prevention impact
Quantify and report cost savings and cost avoidance resulting from fraud prevention and detection initiatives
Leverage data mining and trend analysis to identify emerging fraud schemes and risk areas
Program Development & Continuous Improvement
Lead the development and execution of fraud prevention initiatives, including pre-payment controls and policy enhancements
Identify systemic vulnerabilities and implement proactive interventions to mitigate risk
Drive continuous improvement through benchmarking, regulatory insights, and industry collaboration
Support training and awareness programs related to fraud, waste, and abuse
Required Skills:
Excellent knowledge of relevant laws, regulations and industry standards
CDPAP and Medicaid experience
Experience managing relationships with MFCUs and state oversight agencies
Ability to communicate complex compliance issues clearly and effectively
Expert in FWA and ANE investigative processes
Strong analytical, interpersonal, and organizational skills
Proficiency in Microsoft Office technology; comfortable learning new systems and communicating system design needs
Demonstrated competence in reviewing contracts and other legal and regulatory documents
Strong attention to detail and process improvement
Excellent written and oral communication skills
Ability to negotiate with partners for prioritization and resource allocation
Comfortable with healthy conflict
Skilled at developing and maintaining accountability within corporations
Demonstrated ability to build highly effective teams and manage staff
Strong work ethic and ability to prioritize tasks in a fast-paced, dynamic environment
Qualifications:
Education:
Bachelor’s degree preferred; Substantial professional experience may be considered in lieu of a formal degree.
Experience:
10+ years of relevant work experience in a compliance leadership role required
5+ years of leadership experience
Experience with fraud waste and abuse prevention, detection, investigation and management in healthcare
Experience in managing regulatory relationships and audits (both internal and external) required
Experience with government contracts and familiarity with Medicaid
Certification: CFE or AHFI highly desirable
Working Conditions
Remote with occasional business travel
Compensation & Benefits:
401k Retirement Plan
Medical, Dental and Vision insurance on first day of employment
Generous Paid Time Off
Employee Assistance Program and more
Compensation range: $145,000 - $160,000 annually
The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified
Public Partnerships is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PPL, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PPL will not tolerate discrimination or harassment based on any of these characteristics. PPL believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
