Medicaid Program Integrity Senior Consultant

Our goal is to solve problems and deliver results for our clients. At Cloud and Things, you can be a part of transforming the public sector’s IT environment. Our team is on the forefront of helping to solve the government's most complex IT challenges. If you are seeking a role that offers the opportunity to work on rewarding projects, consider a career with Cloud and Things.

• This is an exempt position. Salary commensurate with experience*

Overview: Location: Remote with periodic travel required Salary: $140,000 - $155,000 We are seeking a Medicaid Program Integrity Senior Consultant who will support our client. This position offers the opportunity to partner with state Medicaid agencies and the Centers for Medicare & Medicaid Services (CMS) to implement effective program integrity initiatives that prevent and detect fraud, waste, and abuse. You will help Medicaid agencies safeguard federal and state resources while supporting access to vital healthcare services. Duties:

• Establish and improve Medicaid program integrity procedures, tools, and knowledge through regulatory analysis, documentation review, and data assessment.
• Provide actionable recommendations to clients to strengthen program integrity functions.
• Conduct audits of Medicaid program operations and providers, with a focus on identifying fraud, waste, and abuse.
• Analyze federal and state regulations and sub-regulatory guidance to inform Medicaid program integrity activities.
• Manage and support program integrity initiatives, ensuring timely and accurate project delivery.
• Communicate effectively with clients, exercising sound judgment, expertise, and attention to detail to support project progress and client satisfaction.
• Collaborate with team members to enhance client service offerings and share program integrity knowledge.
• Support professional development of peers while pursuing continuous growth in your own expertise.

Mandatory Qualifications:

• 10+ years of experience working in a state Medicaid agency, CMS, or public auditor’s office with progressive responsibility in Medicaid program integrity functions.
• Demonstrated expertise in Medicaid program integrity audits or in providing program integrity services as a contractor/vendor.
• Strong experience analyzing regulations and sub-regulatory guidance to inform program integrity work.
• Proven project management experience related to program integrity initiatives.
• Extensive experience conducting audits of Medicaid program operations and providers, including investigations into fraud, waste, and abuse.
• Demonstrated success in navigating large government departments and agency structures.
• Excellent written, verbal, and interpersonal communication skills.
• Strong team collaboration skills with the ability to lead, mentor, and partner effectively.

Desirable Qualifications:

• Medical coding expertise.
• Previous consulting experience supporting state Medicaid agencies.
• Familiarity with Guam Medicaid programs or working across diverse geographic regions.

Cloud and Things complies with all applicable federal, state, and local laws regarding recruitment and hiring. All qualified applicants are considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, or any other category protected by applicable federal, state, or local laws. AI-Assisted Resume Evaluation Notice Cloud and Things – Talent Management Notice to Candidates Cloud and Things utilizes artificial intelligence (AI) tools to assist our recruiting team in evaluating candidate applications for streamlining; consistency, efficiency, and thoroughness. All hiring decisions are ultimately made by our human recruiting professionals. How AI Is Used Our AI tools assist by:

• Analyzing resumes against job requirements
• Supporting our recruiters in candidate data evaluation
• Ensuring consistent review standards across all applications

Important: AI serves as a support tool only. As noted above, all candidate selection and hiring decisions are made by experienced human recruiters. Your unedited resume will be processed by our AI tools as part of this evaluation. Your Data and Privacy Cloud and Things Data Handling:

• Your information is processed securely and used exclusively for recruitment purposes
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• You may opt out of long-term ATS storage by emailing your name and your request to opt out of storing your resume in the ATS to: [email protected]
• All personal information is handled confidentially in accordance with our privacy policy

AI Tool Data Processing:

• AI processing data is retained for a maximum of 90 days, after which it is deleted
• All data sent to AI tools is encrypted in transit and at rest
• AI tools comply with applicable privacy laws including GDPR and CCPA
• Personal data is anonymized or minimized wherever possible during AI processing

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