Director, Program Integrity, Health & Human Services
hace 16 horas
New York
The KPMG Advisory practice is at the forefront of transformation, offering excellent opportunities for individuals to advance their careers and expertise with KPMG. Looking ahead, we anticipate continued evolution and success within the practice, fostering both personal and professional development, thereby creating new pathways for growth. In this ever-changing market environment, our professionals must be adaptable and thrive in a collaborative, team-driven culture. At KPMG, our people are our number one priority. With a wealth of learning and career development opportunities, a world-class training facility, and leading market tools, we help our people continue to grow both professionally and personally. If you're looking for a firm with a strong team connection where you can be your whole self, have an impact, advance your skills, deepen your experiences, and have the flexibility and access to constantly find new areas of inspiration and expand your capabilities, then consider a career in Advisory. KPMG is currently seeking a Director, Program Integrity, Health & Human Services to join our ___ practice. Responsibilities: • Provide technical and strategic advisory services related to program integrity, compliance, and fraud, waste, and abuse (FWA) across Health and Human Services (HHS) programs, including Medicaid, HR1-related programs (such as SNAP), rural health, childcare, child welfare, and child support enforcement; Support the design, implementation, and operation of end to end program integrity frameworks, including policy and procedure development, governance models, internal controls, and operating structures, • Lead and oversee risk assessments, gap assessments, and fraud risk assessments to identify program vulnerabilities and prioritize integrity and compliance activities; Direct and support compliance reviews, audits, investigations, and third party/subrecipient monitoring, including desk and field audits; design and oversee FWA prevention and detection strategies, leveraging data analytics, automated flags, trend analysis, dashboarding, and reporting, • Develop and monitor corrective action plans (CAPs) and continuous improvement efforts to remediate findings and strengthen program controls; Support provider and participant integrity activities, including credentialing, background checks, eligibility-related reviews, and forensic analysis, • Provide guidance on regulatory compliance with federal and state requirements and translate policy and regulatory expectations into practical, operational solutions; Provide program integrity leadership across financial, reimbursement, and fiscal administration functions, including rate setting, cost reporting, managed care oversight, and federal claiming, to identify and mitigate fraud, waste, and improper payments, • Contribute to KPMG's thought leadership by authoring professional articles, participating in industry and regulatory forums, and speaking at external events on program integrity and FWA topics; as well as lead and actively participate in business development efforts, including client relationship management, proposal development, and expansion of program integrity services across HHS clients, • Oversee team operations by planning, scheduling, and assigning work; provide leadership in recruiting, developing, and retaining talent to grow the program integrity practice, • Act with integrity, professionalism, and personal responsibility to uphold KPMG's respectful and inclusive work environmentQualifications:, • Minimum eight years of recent and applicable experience in program integrity, compliance, audits, investigations, or FWA-related roles, supporting federal or state HHS programs, including Medicaid and/or human services programs (such as SNAP, child welfare, childcare, child support enforcement), • Advanced degree from an accredited college or university is preferred; Minimum of a Bachelor's degree is required; preferred certifications include CFE, CGFM, PMP, CPA or other relevant credentials, • Strong working knowledge of federal and state laws, regulations, and guidance governing Medicaid and human services programs, • Experience designing and executing program integrity strategies, compliance reviews, and FWA prevention and detection initiatives; experience in Medicaid finance, healthcare finance, reimbursement, or fiscal administration, including roles such as Medicaid CFO, Deputy CFO, finance director, or consulting roles supporting state HHS or Medicaid agencies, • Demonstrated experience with Medicaid rate setting, cost reporting, managed care financial oversight, federal claiming, or financial audits, and their intersection with program integrity and compliance., • Demonstrated experience leading teams and managing complex, multi-disciplinary engagements, with an active role in execution and delivery; proven success in client service and business development within an advisory or consulting environment; exceptional interpersonal and communication skills, with the ability to build credibility and trust with senior government and organizational leaders, • Willingness to travel as needed, which may be up to eighty percent
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