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Medicare Medicaid Program Integrity Manager Jobs

USMax

Medicare/Medicaid Program Integrity Advisor

Medicare/Medicaid Program Integrity Advisor USmax is seeking a Medicare/Medicaid Program Integrity ... management, and support services. Our services based on trust, quality, efficiency, and innovation ...

BerryDunn

Medicaid Program Integrity Senior Consultant

$118K - $119K/yr

... Medicaid Program Integrity initiatives as a forensic analyst. You will perform claims audits ... Support the review of operational data related to provider management, member services, financial ...

CVS Health

Program Integrity Manager

$60K - $132K/yr

Position Summary The Program Integrity Manager serves as a key leader supporting Medicaid Program Integrity, Payment Integrity, and Special Investigations Unit (SIU) activities. This role is ...

State of Alaska

Medicaid Program Associate

Juneau, AK · On-site

$27.46/hr

... manage information will help the Medicaid Program Integrity team ensure identified issues are ... Medicare and Medicaid Services (CMS), the National Association for Medicaid Program Integrity ...

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How much do medicare medicaid program integrity manager jobs pay per year?

As of Sep 7, 2026, the average yearly pay for medicare medicaid program integrity manager in the United States is $107,460.00, according to ZipRecruiter salary data. Most workers in this role earn between $79,500.00 and $132,500.00 per year, depending on experience, location, and employer.

What does a Medicare Medicaid Program Integrity Manager do?

A Medicare Medicaid Program Integrity Manager is responsible for overseeing efforts to prevent, detect, and address fraud, waste, and abuse within Medicare and Medicaid programs. They develop and manage compliance strategies, conduct audits and investigations, and ensure that healthcare providers and beneficiaries follow federal and state regulations. Their work helps protect public funds and maintain the integrity of government healthcare programs.

What are the key skills and qualifications needed to thrive as a Medicare Medicaid Program Integrity Manager?

To thrive as a Medicare Medicaid Program Integrity Manager, you need expertise in healthcare compliance, fraud detection, regulatory policy, and a bachelor's degree in healthcare administration or a related field. Familiarity with data analytics tools, case management systems, and regulatory databases such as CMS is typically required, along with certifications like Certified Professional in Healthcare Quality (CPHQ) or Certified Fraud Examiner (CFE). Strong analytical thinking, leadership, and effective communication skills are essential for coordinating investigations and collaborating with stakeholders. These skills and qualifications are crucial for upholding program integrity, minimizing fraud and abuse, and ensuring adherence to government healthcare regulations.

How does a Medicare Medicaid Program Integrity Manager typically collaborate with compliance teams and federal auditors?

A Medicare Medicaid Program Integrity Manager regularly works alongside compliance teams to develop and implement processes that detect and prevent fraud, waste, and abuse in government healthcare programs. They also serve as a key liaison during audits and investigations conducted by federal agencies, ensuring that all requested documentation is accurate and submitted promptly. Frequent communication and coordination with both internal teams and external auditors are essential, as these partnerships help maintain program integrity and regulatory compliance.
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Medicare Medicaid Program Integrity Manager jobs near you
Infographic showing various Medicare Medicaid Program Integrity Manager job openings in the United States as of August 2026, with employment types broken down into 95% Full Time, and 5% Temporary. Highlights an 75% In-person, 5% Hybrid, and 20% Remote job distribution, with an average salary of $107,460 per year, or $51.7 per hour.

Medicare/Medicaid Program Integrity Advisor

USMax

Remote

Other

Posted 5 days ago

Job description

Medicare/Medicaid Program Integrity Advisor

USmax is seeking a Medicare/Medicaid Program Integrity Advisor for the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS), and the Center for Program Integrity (CPI).

This role will support events, e-learning curriculum, and course development. This includes developing and updating educational and outreach materials (courses, tools, fact sheets, etc.) for fraud, waste, and abuse (FWA), and analyzing and identifying education and outreach opportunities to address vulnerabilities and known fraud schemes within CMS programs. The Medicare/Medicaid Program Integrity (PI) Advisor will ensure quality and compliance with current CMS guidance and regulations.

Duties and Responsibilities:

  • Perform a thorough review of peer submissions to ensure submission quality and compliance with current CMS guidance and regulations
  • Serve as the Program Integrity subject matter expert and provide guidance on CMS PI-related questions and initiatives
  • Stay current with emerging CMS PI guidance, industry expectations, and standards, and demonstrate the ability to translate these into educational materials for CPI stakeholders
  • Research and interpret CMS regulations, guidance, manuals, and policy updates
  • Provide expert consultation regarding Program Integrity initiatives
  • Review educational content for technical accuracy
  • Identify emerging fraud schemes and vulnerabilities
  • Recommend outreach and training strategies
  • Participate in stakeholder meetings and workgroups
  • Support development of fact sheets, toolkits, webinars, and training products
  • Other duties as assigned

Required Qualifications:

  • Proficient in Microsoft Office Applications (Microsoft Outlook, Word, Excel, PowerPoint, and SharePoint); advanced knowledge of Excel formulas preferred
  • Excellent verbal and written communication and presentation skills
  • Ability to proactively anticipate project needs, support project strategy and implementation
  • Organized, detail-oriented, self-motivated, efficient, flexible, and able to meet deadlines
  • Experience executing in a high-paced, evolving environment with short deadlines
  • Ability to comprehend and provide analysis of deliverables and related customer-facing materials
  • Ability to demonstrate sound judgment, attention to detail, and critical thinking
  • Ability to work independently

Required Experience:

  • Five years minimum experience supporting Medicare, Medicaid, or healthcare Program Integrity initiatives
  • Thorough understanding of CMS Program Integrity regulations, Medicare and Medicaid guidance, policy directives, and related federal requirements
  • Demonstrated expertise in CMS Program Integrity operations and policy

Required Education:

  • Bachelor's degree

Preferred Experience:

  • Seven to ten years supporting CMS CPI initiatives
  • Five years reviewing policy and regulatory guidance

Security Clearance Requirements:

  • N/A

Work Location / Schedule:

  • Remote position

USmax Corporation is an award-winning SBA Certified Woman-Owned Small Business and leading provider of innovative professional, technical and enterprise IT services. Our client areas span, national security, public safety and healthcare markets.

Our commitment to quality and continuous process improvement is demonstrated by our ISO 9001:2015, ISO 20000-1:2018, and ISO 27001:2013 registrations. We offer complete program life cycle support through a full range of planning, design, implementation, management, and support services. Our services based on trust, quality, efficiency, and innovation drive the mission of our various federal and commercial customers.

USmax is certified by the Commonwealth of Virginia Department of Veterans Services as a Virginia Values Veterans (V3) Facility and certified as a V3 Certified Employer. USmax is an avid supporter of the men and women who have served our country. This certification recognizes this achievement and furthers our commitment to veterans and their families.

USmax is an Equal Opportunity Employer. Please see our website to learn more about our employment policies or to request accommodation to enable you to apply for employment.

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