Senior Manager, Federal Healthcare Program Integrity & Advanced Analytics (AI)

Location: Bethesda, MD, United States

Company

hirify.global is a public-sector consulting and information technology solutions provider supporting health, civilian, and national security missions.

What you will do

• Lead the development and delivery of data-driven solutions for federal healthcare program integrity.
• Help prevent, detect, investigate, and mitigate fraud, waste, abuse, improper payments, and other program-integrity vulnerabilities.
• Translate healthcare fraud and integrity challenges into hirify.globall strategies, risk indicators, investigative leads, and measurable mitigation approaches.
• Work with program-integrity leaders, investigators, analysts, clinicians, auditors, policy experts, data scientists, and technology teams.
• Support work and growth across CMS, the Defense Health Agency, the Department of Veterans Affairs, and adjacent federal healthcare organizations.
• Contribute customer insight, professional relationships, technical leadership, solution concepts, capture activities, and proposal efforts.

Requirements

• Master’s degree or doctorate in a relevant quantitative, healthcare, economics, public policy, informatics, or technology discipline.
• Direct experience supporting federal healthcare program integrity, fraud prevention, investigation, payment integrity, oversight, or enforcement, particularly involving CMS, DHA/Military Health System/TRICARE, HHS OIG, DOJ healthcare fraud initiatives, or state Medicaid program integrity.
• Deep experience with one or more federal healthcare domains, including Medicaid, Medicaid managed care, Medicare Fee-for-Service, Medicare Advantage, Part D, TRICARE, provider enrollment, pharmacy, or healthcare claims.
• Experience supporting healthcare fraud investigations or developing fraud indicators, risk scores, anomaly and outlier methods, entity resolution, network analysis, provider profiles, or investigative lead-generation models.
• Experience evaluating program-integrity interventions and translating hirify.globall findings into actionable investigative, payment-integrity, or program decisions.
• Experience with modern analytics environments and technologies, including Python, SAS, R, SQL, Databricks, Snowflake, cloud data platforms, ML/AI platforms, or graph technologies.
• Experience applying NLP, LLMs, RAG, OCR, semantic analysis, entity resolution, network/link analysis, or other AI techniques to complex healthcare or investigative information.
• Familiarity with responsible AI, model validation and explainability, privacy, security, and federal healthcare data governance.
• Experience contributing to federal solution development, capture, proposals, client engagement, or growth activities.
• Established professional network within the federal healthcare, program-integrity, investigative, analytics, or government-contractor community.
• Excellent written, verbal, presentation, and facilitation skills.
• Ability to obtain and maintain the federal suitability, Public Trust, or other clearance required for assigned work.

Nice to have

• Recognized healthcare or program-integrity thought leadership through client leadership, publications, presentations, professional associations, government working groups, or industry forums.

Culture & Benefits

• Work supporting public-sector health, civilian, and national security missions.
• Opportunity to collaborate across healthcare program integrity, investigations, analytics, policy, clinical, audit, and technology disciplines.
• hirify.global is an established SBA small business and a federal contractor.
• AI-assisted tools may support application review and interview note-taking; hiring decisions are made by recruiters and hiring managers.