Compliance Manager – Program Integrity Unit

Website Florida Department of Management Services

The Department is seeking an experienced professional to lead the Program Integrity Unit in the Division of State Group Insurance (DSGI). The Program Integrity Unit was established to detect and prevent fraud, waste and abuse related to the State Employees’ Group Health Insurance Program. This position will be responsible for developing a comprehensive anti-fraud program, including management of processes to detect and develop leads related to fraud, waste and abuse committed by providers and recipients through research and analysis of data. This position requires a high degree of confidentiality, accuracy, and adherence to deadlines.

Salary: $100,000 – $110,000

Key responsibilities include, but are not limited to, the following:

Strategy and Unit Operations: Lead and direct the daily operations of the Program Integrity Unit. Plan, develop, and implement policies and procedures related to fraud detection efforts; ensure consistency and support regarding specific Program Integrity Unit protocols.

Assist with the preliminary identification of deficiencies in statutory, contractual, and administrative authority related to contracted providers’ responsibilities; identifying potential overpayments, suspected fraud, administrative sanctions or other remedies. Provide technical assistance in directing the review and revision to state laws, rules, regulations, and policies that facilitate the work of DSGI as it relates to detection activities.

Maintain up-to-date knowledge concerning relevant Florida Statutes, including future programmatic endeavors as well as current and past processes to facilitate program integrity efforts. Foster relationships with local, state, and federal partners and staying current with national program developments. Remain informed about program integrity issues and maintains up-to-date knowledge about auditing and investigative techniques.

Coordinate the development and implementation of procedures with Office of the General Counsel and Inspector General, and serves as a liaison with regard to activities related to fraud and abuse. Liaison activities include meeting and coordination of efforts with internal and external partners related to program integrity matters.

Provide status updates, reports, presentations and other materials in preparation of executive and legislative briefings. Develop and maintain work plans and strategic plans to identify deliverables and impacts to members and other stakeholders, and to ensure key milestones are met. Provides recommendations regarding prioritization of work, enforcement of policies, strategic planning and staffing.



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