Senior Director, Payer Government Programs Compliance & Operations Consulting

Ankura is a team of excellence founded on innovation and growth.

Ankura’s Disputes and Economics Healthcare practice is seeking an experienced Senior Director for our payer government programs compliance & operations consulting services.

This exciting position will focus on driving value to clients through compliance, disputes, and investigations and advisory services. The position has tremendous growth potential with one of the leading professional services firms in the United States. The healthcare group is the largest industry group within Ankura. This position is remote with a preference of the ability to travel to one of our large office locations (New York, D.C. Chicago) to work with key leaders and team members.

Role Purpose:

The Senior Director helps lead and manage the day-to-day multi-workstream engagements. This is a player-coach role, this position maintains a client relationship, leads a team of two to four consultants, and contributes directly to workstreams. This hire also carries a business development expectation: generating qualified add on work introductions from current engagements and contributing to proposals. The ideal candidate has sat on both sides of the table, they have worked inside a health plan/healthcare setting, and they have delivered consulting engagements to health plan clients, which gives them credibility with clients and the delivery skills the role requires.

Core Requirements:

• CMS Program Audit experience — direct engagement with ODAG, CDAG, FA, SNP-CC, or CPE protocols as an audit lead or senior consultant supporting plan-side audit defense

• Compliance program design and assessment — ability to evaluate a plan's compliance program against OIG guidance and CMS expectations, identify material gaps, and develop a remediation roadmap

• Managed Medicaid and ACA product awareness – ability to read and interpret regulatory guidance and apply to operational reality.

• Medicaid Managed Care Audits – Ideally experienced in California Department of Health Care Services (DHCS) audits, and Service Level Agreement requirements for different states i.e. Indiana, Ohio, Tennessee.

• Engagement economics — P&L awareness, budget management, staffing decisions, and scope management judgment

• Executive communication — comfortable presenting to a plan's Chief Compliance Officer, Board Compliance Committee, or outside counsel

• Proposal and business development contribution — prior experience contributing to RFP responses, SOW scoping, and client pitches

• Deep understanding of CMS Part C & D annual calendar, key dates (new plan applications, service area expansions, model of care submissions, bid submissions, proposed/final rules), and SNP strategies; able to stimulate client thought and support through the comment submission process.

• Knowledgeable in the Paperwork Reduction Act of 1995 (PRA) and CMS's process for bringing new documents (program audit protocols, data requests, surveys) to published, actionable states.

• Must be legally authorized to work in the United States with the need for employer sponsorship, now or at any time in the future.

Types of Engagements this Role Will Work on:

• Independent monitorship engagements (state AG enforcement actions, OIG CIAs)

• CMS Program Audit readiness and mock audit programs

• Compliance program effectiveness assessments

• SNP and government program launch advisory

• FDR/delegation oversight program design and audit

Ankura is an Affirmative Action and Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability. Equal Employment Opportunity Posters, if you have a disability and believe you need a reasonable accommodation to search for a job opening, submit an online application, or participate in an interview/assessment, please email [email protected] or call toll-free +1.312-583-2122. This email and phone number are created exclusively to assist disabled job seekers whose disability prevents them from being able to apply online. Only messages left for this purpose will be returned. Messages left for other purposes, such as following up on an application or technical issues unrelated to a disability, will not receive a response.