Strategic Program Manager leading multi - functional projects to drive business growth at PGIM. Collaborating across teams and modernizing processes within the asset management sector.
About the role
- Program Director overseeing contract requirements and operations for Medicare and Medicaid in the Midwestern Region. Ensuring compliance, quality assurance, and stakeholder communication for federal health agency.
Responsibilities
- Oversight of contract requirements and jurisdictional operations
- Lead, manage, and support a team
- Ensure appropriate staffing and resource allocation
- Maintain effective communication with internal staff and external stakeholders
- Ensure compliance with contract requirements including quality, cost control, and timeliness
- Implement and maintain a quality assurance program
- Submit timely and accurate monthly cost reports and corrective action plans as needed
- Ensure timely and quality submission of deliverables and ad hoc requests
- Maintain superior business relations with CMS, Law Enforcement, MACs, and other partners
Requirements
- Bachelor's degree with 20 years of professional experience OR Master’s degree with 15 years of professional experience
- At least eight years in healthcare, Medicare, Medicaid, or related private insurance field
- Minimum of seven years in a progressive management capacity with responsibility for managing complex systems and workflows
- US Citizenship is required
- Must be able to obtain Public Trust clearance
- Intensive experience conducting and overseeing healthcare fraud investigations for healthcare payers and/or law enforcement
- Customer familiarity with the CMS Center for Program Integrity (CPI)
- Expertise in the Medicare program and the CMS/CPI’s fraud, waste, and abuse workflow
- Credentials such as: Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AFHI), or similar
- Proficiency in MS Office Applications (Word, PowerPoint, Outlook, Excel, Project) and MS SharePoint.
Benefits
- Reasonable Accommodations are available
- Equal Opportunity Employer
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