Job Title: Program Compliance and Review Manager
Location- Baltimore, MD (Hybrid)
Duration- 5 Years
Job Summary
We are seeking a senior-level Program Compliance and Review Manager to oversee quality assurance, case management compliance, internal reviews, risk-based monitoring, and corrective action activities for a large-scale government assistance program.
The ideal candidate will have strong experience in compliance, quality assurance, internal auditing, case management, program integrity, or operational review within a regulated environment. Experience supporting government, human services, public benefits, Medicaid, SNAP, childcare subsidy, or similar programs is highly preferred.
Responsibilities
- Oversee quality assurance and compliance review activities across program operations.
- Develop and implement risk-based monitoring and review frameworks.
- Conduct and/or oversee internal audits, case file reviews, compliance reviews, and operational assessments.
- Identify operational control gaps, compliance deficiencies, documentation issues, and process risks.
- Develop, implement, and track corrective action plans.
- Monitor corrective actions through completion and assess the effectiveness of remediation efforts.
- Establish review methodologies, quality standards, sampling approaches, and monitoring procedures.
- Analyze review findings and identify trends, recurring issues, and opportunities for improvement.
- Prepare compliance reports, dashboards, presentations, and management summaries.
- Communicate findings, risks, and recommendations to leadership and operational teams.
- Partner with case management, eligibility, customer service, training, and other teams to improve operational quality and compliance.
- Support the development and enhancement of policies, procedures, internal controls, and quality standards.
- Support internal and external audits, monitoring activities, and compliance requests.
- Provide guidance and mentorship to compliance, quality assurance, audit, or review staff as needed.
Required Qualifications
- Demonstrated knowledge of case management processes and quality assurance practices.
- Senior-level experience developing or implementing risk-based monitoring frameworks.
- Experience conducting internal audits, compliance reviews, quality reviews, or operational assessments.
- Demonstrated ability to identify operational control gaps and compliance deficiencies.
- Experience developing and tracking corrective action plans.
- Strong analytical, problem-solving, communication, and reporting skills.
- Ability to work effectively with cross-functional teams and senior stakeholders.
Preferred Qualifications
- Experience supporting state government, human services, social services, public benefits, Medicaid, SNAP, childcare subsidy, or similar programs.
- Experience with eligibility determination, case processing, case file reviews, program integrity, or quality monitoring.
- Experience leading compliance, audit, program integrity, or operational quality assurance teams.
- Experience working in a highly regulated or contract-driven environment.
- Certification in internal auditing, compliance, ethics, or regulatory compliance.
- CIA, CCEP, CRCM, or comparable certification is preferred.
- Bachelor’s degree in business, public administration, accounting, finance, compliance, social services, or a related field is preferred.
- 10+ years of relevant experience in compliance, quality assurance, audit, program integrity, case management oversight, or a related area is preferred.
Key Skills
Program Compliance | Quality Assurance | Internal Auditing | Risk-Based Monitoring | Program Integrity | Case Management | Eligibility Operations | Case File Review | Corrective Action Plans | Operational Risk Management | Process Improvement | Compliance Reporting
