Medicaid Risk & Compliance Consultant
A leading healthcare consulting organization is seeking an experienced professional to support large-scale public healthcare programs focused on operational effectiveness, compliance oversight, regulatory alignment, and program performance improvement.
This position offers the opportunity to work directly with healthcare leaders on complex initiatives involving program evaluation, risk identification, operational assessments, stakeholder engagement, audit support, and strategic process improvement. The role combines consulting, project leadership, and subject matter expertise within highly visible client engagements.
Key Responsibilities
- Lead projects focused on healthcare program oversight, operational compliance, performance improvement, and risk mitigation.
- Advise clients on regulatory requirements, industry best practices, and evolving healthcare policy considerations.
- Evaluate operational processes and identify opportunities to strengthen controls, improve outcomes, and enhance program effectiveness.
- Develop executive-level analyses, reports, presentations, and strategic recommendations.
- Manage multiple project workstreams, timelines, budgets, and stakeholder communications.
- Partner with healthcare executives, operational leadership teams, providers, vendors, and external stakeholders to support critical initiatives.
- Oversee project deliverables and ensure high-quality results across cross-functional teams.
- Mentor junior consultants and contribute to practice development, knowledge-sharing, and thought leadership efforts.
- Support new business initiatives and help expand client relationships through trusted advisory services.
Ideal Background
- 7+ years of experience in healthcare operations, compliance, audit, risk management, program oversight, investigations, payment integrity, or regulatory affairs.
- Experience supporting complex healthcare organizations, government-sponsored healthcare programs, managed care organizations, consulting firms, or regulatory agencies.
- Strong analytical, problem-solving, and project management skills.
- Proven ability to lead initiatives involving multiple stakeholders and competing priorities.
- Strong written, verbal, and executive-facing communication skills.
Preferred Experience
- Experience within government healthcare programs, managed care organizations, healthcare consulting firms, regulatory entities, or healthcare payer operations.
- Background supporting audit readiness, compliance reviews, operational monitoring, investigations, quality assurance, or performance improvement initiatives.
- Professional certifications such as CFE, CPC, CPMA, CIA, PMP, or related credentials.
- Prior consulting or advisory experience in healthcare environments.
FAQs
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