US E-GPS Consulting Services-Risk, Compliance, and Governance Domain Senior Manager-RR&F/EO&R-Domain (PD1)

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US E-GPS Consulting Services-Risk, Compliance, and Governance Domain Senior Manager-RR&F/EO&R-Domain (PD1)

senior · Risk & Compliance

Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk and an evolving regulatory environment into defensible actions that strengthen, protect, and transform their organization. Join our team and use advanced data, AI, and emerging technologies with industry insights to help clients bring clarity from complexity and accelerate their path to value creation.

Work You’ll Do

As a Risk, Compliance, and Governance Domain Senior Manager, you will have the opportunity to help our clients mitigate risks related to health care fraud, waste, and abuse, as well as to improve their ability to meet regulatory requirements, expectations, and guidance in support of developing and maintaining sound program integrity and compliance programs and controls. You will build your professional skills in a variety of project experiences by assisting our clients to understand the complexities of the issues they face, and by implementing solutions to help them remediate identified issues. 

• Provide regulatory, operational and technology insights in health care fraud-related topics (e.g., Medicare/Medicaid program integrity, False Claims Act, Anti-Kickback Statute, and Stark Law compliance).
• Analyze and optimize Fraud, Waste, and Abuse (FWA) compliance processes, systems, and technology.
• Develop and implement corrective action plans for the resolution of issues and provide guidance on how to avoid or deal with similar situations in the future.
• Keep abreast of regulatory developments both within and outside of the company, as well as evolving best practices in health care program integrity, fraud, compliance, and enforcement.
• Prepare and present clear and concise presentations, reports, and proposals to senior leaders, and government officials; both at our clients and within Deloitte.
• Lead, plan, and manage projects, including writing proposals, defining scope, overseeing fieldwork, and preparing deliverables, ensuring that a high-quality integrated service is provided on time.
• Leading and mentoring professional teams on projects.
• Develop and coach team members.
• Assessing health care fraud and program integrity risks at the enterprise and business unit level.
• Overseeing large-scale programs including claims data analytics reviews, provider screening, compliance program assessments, and investigations.

A successful candidate would possess these skills:

• Ability to work independently and collaborate as part of a team.
• Effective written and verbal communication skills.
• Meticulous attention to detail and quality of work product.
• Ability to build and sustain professional relationships.
• Ability to lead projects or workstreams.
• Ability to manage and prioritize multiple tasks in a fast-paced and dynamic environment.
• Strong interpersonal skills and professional demeanor.
• Ability to meet deadlines.
• Ability to mentor and provide clear guidance to others.

The Team

Deloitte’s Government & Public Services (GPS) practice – our people, ideas, technology and outcomes – is designed for impact. Serving federal, state, & local government clients as well as public higher education institutions, our team of professionals brings fresh perspective to help clients anticipate disruption, reimagine the possible, and fulfill their mission promise.

Our Enterprise Operations & Risk offering enables clients to achieve profitable growth and competitive advantage by optimizing “heart of the business” operations. Leverages deep domain expertise to extend enterprise resilience, agility and remediation. Addresses client needs which span the organization and impact strategy, operations, performance and reputation.

Qualifications

Required: 

• Bachelor’s degree
• 10+ years of experience in federal, state, or private-sector health care fraud investigations, compliance, or program integrity activities, including management experience.
• 10+ years of experience in health care fraud detection, data analytics, and case management systems and related software.
• Subject matter expertise in health care fraud, waste, and abuse laws and regulations as they apply to Medicare, Medicaid, and other federal and state health care programs.
• Experience leading and managing multidisciplinary teams of investigative, analytical, and/or compliance professionals.
• Must be able to obtain and maintain the required clearance for this role.
• Ability to travel 25-75%, on average, based on the work you do and the clients and industries/sectors you serve.
• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Preferred: 

• Ability to provide advice regarding applicable health care fraud regulations and requirements to stakeholders on regulatory, operational, and documentation issues. 
• Experience submitting written and oral reports to senior stakeholders or clients.
• Excellent written and verbal communication skills.
• Strong analytical and investigative skills.
• Strong attention to detail and organizational skills.
• Proven experience effectively prioritizing workload, managing multiple priorities, and quickly adapting to meet deadlines and work objectives.