Program Integrity Director Jobs in Massachusetts

About the Organization:

The Executive Office of Health and Human Services (EOHHS) is comprised of 11 agencies and the MassHealth program.  EOHHS seeks to promote the health, resilience, and independence of the nearly one in three residents of the Commonwealth we serve. Our public health programs touch every community in the Commonwealth.  To know more about EOHHS please visit  https://www.mass.gov/orgs/executive-office-of-health-and-human-services.  

About the Role:

The EOHHS IT team, supporting the MassHealth program within the Executive Office of Health and Human Services (EHS), is seeking a Director of Medicaid Platforms & Products to lead the Commonwealth's core Medicaid technology portfolio, including MMIS, while advancing interoperability, operational excellence, and modernization aligned with CMS Medicaid Enterprise System (MES) guidance.

MassHealth Agency responsible for the Medicaid and CHIP programs for Massachusetts, providing access to healthcare services to approximately 2 million low-income and disabled residents of the Commonwealth. MassHealth is responsible for a ~$22 billion annual budget comprised of insurance premiums, payments for healthcare services, payments for pharmaceutical therapies, administrative expenses, and more.

The Director is responsible for the overall operation of MMIS, including production support, system performance, strategic planning, enhancement delivery, release management, and operational reliability. This role will serve as a key partner to the ACIO for Medicaid Enterprise Systems, helping deliver ongoing Medicaid priorities while addressing challenges related to legacy system dependencies, technical debt, interoperability, technology governance, operational visibility, and alignment with enterprise standards.

The Director will oversee MES modules within the MMIS environment, including Claims Processing, Encounter Processing System (EPS) & Managed Care System, Financial Management, Member Management, Program Integrity, and Provider Management, while supporting interoperability and integration with enterprise systems and services. The role is responsible for coordinating business, vendor, and IT resources to support operational success and the Commonwealth's Medicaid technology transformation roadmap.

The primary work location for this role will be at 1 Enterprise Drive, Quincy, Massachusetts 02171. The work schedule for this position is Monday thru Friday, 9:00AM to 5:00PM EST.  This position would be expected to follow a hybrid model of reporting to work that combines in-office workdays and work from home days as needed.  The Director is expected to occasionally travel to EOHHS, MassHealth or vendor locations within the Commonwealth of MA in support of their work.

This role combines:

• Operational accountability for MMIS and MES platforms, including claims, provider, member, financial, and program integrity functions
• Technology portfolio and delivery leadership
• Cross-team delivery leadership and organizational change
• Vendor, compliance, and operational oversight

The ideal candidate will be:

• a technically proficient leader with the ability to understand complex systems, articulate system interactions and dependencies, and effectively partner with business and technology stakeholders across the enterprise
• a strong operator leader who can manage large-scale complex Medicaid platforms and vendor ecosystems reliably and
• a pragmatic change agent that can improve execution, collaboration and accountability while maintaining operational stability

Responsibilities:

• Accountable for Stability and Performance of MMIS/MES products
• Maintain accountability for the performance, reliability, and compliance of legacy MMIS
• Oversee applications/products for claims adjudication, provider management, member processing, and financial operations
• Ensure continuity of operations excellence, disaster recovery, and system integrity including oversee production support schedules, operational readiness activities, and on-call support processes.
• Ensure operational excellence in management, communication, partnership, and teamwork.
• Develop and strengthen internal understanding of MMIS architecture, business processes, integrations, and operational dependencies to reduce reliance on vendor-held knowledge.
• Develop and execute plans to reduce technical debt, remediate security vulnerabilities, improve maintainability, and increase platform resiliency.
• Oversee planning, forecasting, and reporting of development activities, resource needs, delivery timelines, and modernization initiatives.
• Establish and monitor operational, modernization, and service delivery metrics to drive accountability, performance improvements, and executive decision-making.
• Provide executive leadership during critical incidents, major outages, and operational escalations, ensuring effective communication, root-cause analysis, and remediation planning.
• Directly supervise managers and staff responsible for product, technical services, and contractor oversight functions, including hiring, performance management, disciplinary actions, succession planning, and workforce development.
• Improve Cross-Team Delivery and Break Down Silos
  • Lead efforts to improve coordination across MMIS, MES products, Eligibility & Enrollment modules, Security, Operations, and other teams
  • Establish clear ownership and accountability for cross-team initiatives and outcomes
  • Improve visibility into work, priorities, and delivery status across teams
  • Identify and reduce bottlenecks, handoff delays, and workflow breakdowns
  • Introduce lightweight, practical ways of working that enhance collaboration without adding unnecessary bureaucracy, while ensuring governance remains practical, effective, and agile.
• Establish a More Structured and Transparent Delivery Model
  • Partner with executives and managers to ensure roadmap priorities are clearly defined, communicated and executed.
  • Improve transparency into delivery progress, risks, dependencies, and outcomes.
  • Drive accountability for execution across teams and vendors.
  • Help teams move from reactive, fragmented execution to more coordinated and outcome-driven delivery
• Evolve MMIS toward a CMS-compliant Medicaid Enterprise System (MES)
  • Develop and execute a roadmap to transition from a monolithic MMIS to a modular MES ecosystem.
  • Own and maintain the multi-year MMIS/MES technology roadmap, including modernization priorities, interoperability initiatives, technical debt reduction, platform lifecycle management, and CMS-aligned MES transformation planning.
  • Establish and recommend technology strategies, modernization priorities, governance frameworks, and implementation policies supporting MMIS and MES platforms.
  • Improve interoperability across systems and external partners
  • Create governance to have an integrated MES ecosystem with modules and systems managed by other EOHHS entities such as Eligibility & Enrollment and Decision Support System & Data Warehouse
  • Align with CMS principles including modularity, MITA maturity, and shared services
  • Partner with Enterprise Architecture and technology leadership to establish technical standards, integration patterns, API strategies, and modernization approaches across MMIS and MES platforms.
• Lead Organizational Effectiveness and Delivery Improvements
  •  Improve accountability, communication, and coordination across teams supporting MMIS and MES.
  • Build a culture of:
    • shared accountability
    • collaboration across teams
    •  openness to new ways of working

• Implement changes in a measured manner that supports operational continuity and staff engagement.
  • Lead implementation of practical delivery management practices, including Agile, iterative, or hybrid approaches appropriate for operational Medicaid environments
• Partner Across Business and IT
  • Work closely with MassHealth business leaders and product owners to align on priorities and outcomes
  • Translate business needs into coordinated technology delivery
  • Strengthen partnership between business and IT to ensure shared ownership of outcomes
• Vendor and Financial Management
  • Lead a multi-vendor ecosystem supporting MMIS operations, MES transformation, cloud services, and enterprise integrations, ensuring alignment with Commonwealth objectives and contractual obligations.
  • Manage vendor relationships (e.g., Gainwell, Smartronix, Presidio, Gartner) and contract performance
  • Review and approve vendor invoices, spending plans, and financial reporting related to MMIS and MES initiatives.
  • Ensure vendors are compliant with EOHHS operational standards, service level agreements (SLAs), and key performance indicators (KPIs).Oversee budget, financial planning, and cost management
  • Lead technology planning activities supporting CMS APDs, MES certification readiness, federal funding opportunities, and Medicaid modernization initiatives.
  • Serve as a key technology liaison supporting CMS interactions related to APDs, certification activities, compliance reviews, and modernization initiatives.
• Align with Enterprise Shared Services
  • Partner with enterprise teams supporting operations, security, testing, and data services to ensure effective integration and delivery of MMIS and MES capabilities.
  • Ensure MMIS or MES integrates effectively with enterprise platforms and services

Required Qualifications

• 5-10 years of senior-level leadership experience overseeing technology, operations, enterprise applications, or large-scale service delivery organizations.
• Experience leading large-scale, mission-critical enterprise applications that support complex business operations, regulatory requirements, and high-volume transaction processing (e.g., Medicaid enterprise systems (MMIS/MES), healthcare payer platforms, financial systems, or other large public-sector technology environments).
• Experience overseeing complex application ecosystems with numerous integrations, interfaces, vendors, and external dependencies.
• Experience managing operationally critical systems requiring high availability, regulatory compliance, and continuous delivery of policy-driven changes.
• Demonstrated success improving delivery execution, collaboration, and accountability across cross-functional teams in complex organizational environments.
• Experience leading organizational and cultural change initiatives, particularly in environments with established silos and competing priorities.
• Proven ability to build trust, alignment, and productive working relationships across teams with differing goals, operational responsibilities, and levels of readiness for change.
• Strong stakeholder management skills, with the ability to effectively navigate competing priorities and drive consensus among diverse stakeholder groups.
• Experience managing vendors, strategic partnerships, and large-scale technology contracts.
• Proven ability to influence leaders and teams outside of direct reporting relationships to achieve shared organizational outcomes.
• Demonstrated success implementing operational improvements that result in measurable gains in delivery performance, collaboration, efficiency, or service reliability.
• Excellent written, verbal, and executive-level communication skills.

Preferred Qualifications

• Understanding of enterprise application architecture, system integration patterns, and large-scale technology ecosystems.
• Experience implementing organizational, operational, or delivery improvements in complex environments with multiple stakeholders and competing priorities.
• Familiarity with Medicaid Enterprise Systems (MMIS/MES), including eligibility and enrollment, provider management, claims processing, and financial operations; knowledge of CMS MES guidance and the MITA framework is preferred.
• Experience managing complex technology environments while maintaining a strong focus on customer service, operational excellence, and regulatory compliance.
• Proven success improving delivery execution, cross-team coordination, transparency, and accountability across large or highly matrixed organizations.
• Experience establishing governance, intake, prioritization, and delivery management processes that improve execution while minimizing unnecessary bureaucracy.
• Demonstrated ability to lead teams through organizational change while maintaining operational stability and meeting delivery commitments.
• Experience implementing Agile, iterative, or hybrid delivery practices that improve coordination, transparency, and execution in operational environments.
• Experience supporting or leading transitions from system-centric to product- or service-oriented operating models.
• Experience working within or alongside shared services organizations.
• Demonstrated ability to simplify processes, reduce organizational complexity, and improve operational effectiveness.
• Experience balancing long-term transformation initiatives with ongoing operational, policy, and regulatory demands.
• Proven success identifying and mitigating workflow bottlenecks, delivery risks, and organizational friction points.
• Experience developing and using operational metrics, dashboards, and KPIs to improve visibility, accountability, and decision-making.
• Experience working in highly regulated healthcare, human services, or public-sector environments.

Pre-Offer Process:

A criminal and tax history background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines. 

Education and license/certification infrmation provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on...