Senior Manager of Program Integrity

MassHealth is the Medicaid and Children's Health Insurance Program (CHIP) for Massachusetts, providing health coverage to approximately 2 million residents and managing an annual budget of approximately $22 billion.

The Office of Accountable Care and Behavioral Health (ACBH) oversees several innovative delivery system and payment reform programs within MassHealth, including Accountable Care Organizations (ACOs), Managed Care Organizations (MCOs), behavioral health program and payment policy, and health-related social needs programs. These programs shape how care is delivered, financed, and evaluated across the MassHealth system and play a critical role in advancing quality, equity, and responsible stewardship of public resources.

The Senior Manager of Program Integrity reports to the Senior Director of Data, Performance, and Reporting and leads strategic efforts to identify, assess, and mitigate fraud, waste, abuse, and other program integrity risks across ACBH programs. This role serves as the primary liaison between MassHealth's centralized Program Integrity team and ACBH program teams, ensuring alignment on priorities and coordinated implementation of program integrity initiatives.

The Senior Manager will work across policy, operations, analytics, and program teams to strengthen oversight processes, implement policy and regulatory changes, manage complex cross-functional initiatives, and provide strategic recommendations to executive leadership. This role is well suited for candidates who enjoy solving complex problems, influencing across teams, and driving meaningful improvements in large-scale healthcare programs.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Serve as the primary liaison between the centralized Program Integrity (PI) team and ACBH program teams; align priorities, facilitate communication, coordinate initiatives, validate PI team findings, and translate between program realities and program integrity objectives to identify balanced, practical solutions.

• Build, implement, and manage structured processes to identify, prioritize, and track program integrity risks and mitigation strategies across program teams, PI, and executive leadership, including establishing workflows, governance structures, and accountability mechanisms.

• Develop, refine, and implement policy and regulatory changes in partnership with program and policy teams, and draft and coordinate related communications to providers and external stakeholders.

• Project manage program integrity initiatives across ACBH, coordinating across program and PI teams to ensure progress, accountability, and timely delivery of key milestones and deliverables.

• Identify data needs and review and synthesize analyses to identify trends, risks, and opportunities for action in collaboration with program, program integrity, and analytics teams.

• Support executive leadership by developing executive-level readouts, synthesizing insights, and providing strategic recommendations to inform decision-making processes.

• Respond to urgent agency, legislative, or regulatory priorities as needed, including rapid analysis, coordination, and communication.

Preferred Qualifications:

• 3–5 years of experience in an analytical, policy analysis, or strategy role.

• Advanced Excel and PowerPoint skills.

• Strong analytical, problem-solving, and communication skills.

• Ability to manage multiple priorities and perform under tight deadlines.

• Experience leading projects and coordinating cross-functional work.

• Strong interpersonal skills and ability to build working relationships.

• Self-starter with an entrepreneurial mindset and ability to work independently.

• Experience in healthcare or related fields.

• Passion for public service.

TO APPLY:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About MassHealth:

The mission of MassHealth is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable health, well-being, independence and quality of life.

For more information about our agency and programs please visit: https://www.mass.gov/orgs/masshealth

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 information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.

If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the ADA Reasonable Accommodation Request Form.

For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have at least (A) five (5) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below.

Substitutions:

I. A certificate in a relevant or related field may be substituted for one (1) year of the required experience.

II. A Bachelor's degree in a related field may be substituted for two (2) years of the required experience.

III. A Graduate degree in a related field may be substituted for three (3) years of the required experience.

IV. A Doctorate degree in a related field may be substituted for four (4) years of the required experience.

Salary placement is determined by a combination of factors, including the candidate’s years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division’s Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer.  Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law.  Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements.  We encourage individuals who believe they have the skills necessary to thrive to apply for this role.