68039492 - PROGRAM ADMINISTRATOR - SES

Requisition No: 865675 

Agency: Agency for Health Care Administration

Working Title: 68039492 - PROGRAM ADMINISTRATOR - SES

Position Number: 68039492 

Salary:  $1,945.56 - $2,529.23 Biweekly 

Posting Closing Date: 12/04/2025 

Total Compensation Estimator Tool

This is a Selected Exempt Service position, anticipated to be filled at the salary rate of $1,945.56 - $2,529.23 biweekly, based upon the selected candidate's experience.

This salaried position is required to work 40 hours per week, Monday-Friday, 8:00 a.m. to 5:00 p.m., with 1-25% travel.

The Agency requires background and fingerprint screening as a condition of employment.

The Florida Medicaid program is one of the five largest in the country and has an estimated $38 billion annual budget. Each month Florida Medicaid covers medical services for almost 4 million recipients.

To most effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste.

The Bureau of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal violations for law enforcement investigation.

This Program Administrator position will support the fraud and abuse prevention efforts within the Bureau of Medicaid Program Integrity (MPI).

MPI is organized by the functions that fall within the Bureau’s responsibility:  Fraud and Abuse Detection, Investigations, Overpayment Recovery, and Managed Care oversight. 

MPI operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission. 

To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units are responsible for developing novel methods and technologies to fight fraud, abuse, and waste.

To do this, these highly collaborative and innovative units rely on teams with diverse educational and experience backgrounds.

One of the responsibilities of the selected candidate for this position is to provide compliance oversight of the Managed Care Plans (MCPs) participating in the Statewide Medicaid Managed Care program to ensure they are meeting program integrity requirements set forth in state and federal law, as well as the provisions of contract and Medicaid policy. 

This selected candidate is also responsible for conducting investigations into possible fraud or abuse committed by the MCPs or their provider networks.

The selected candidate's primary responsibility is the effective management of team members in the Field Operations and Investigations’ Unit. 

This supervisor is responsible for recruiting, hiring, and evaluating the performance of program staff, as well as motivating, training, planning, and directing employees’ work assignments. 

This will include communication, motivation, team building, training and evaluating employees; planning, and coordinating the work initiatives of staff to ensure the timely and efficient performance of assigned duties. 

The selected candidate will assist the Agency for Health Care Administrator for the MPI Miami field office, and fellow Administrators in monitoring, coordinating, and ensuring all MPI audits, investigations, procedural and case related matters are completed in the time restrictions set, while ensuring compliance with applicable statutes, rules, and regulations imposed by MPI and higher authority. 

The position is responsible for assisting MPI investigators, managers, and staff in the analysis and completion of audits and investigations. 

Exceptional research and analytical abilities, along with keen communicative skills are a must for this exciting position.

The selected candidate will monitor legal proceedings, coordinate with legal staff, attend, and participate in depositions, provider meetings, conduct business and corporate entity research, while developing and implementing reports, findings, audits, and investigations in MPI’s fight in the prevention of Medicaid fraud and abuse. 

The incumbent will prepare and review settlement agreements, propose and prepare final orders, craft, and coordinate communications for the bureau.

The Program Administrator will make recommendations and assist in the implementation of policies, procedures, detection and investigative strategies, improving the bureau’s overall mission.

This position has been identified as mission essential.

The incumbent in this position may be required to work during the weekend or on holidays.

In addition, mission essential personnel will be required to work during disasters, to include but not limited to, work before, during and/or beyond normal work hours or days in the event of an emergency.

Emergency work may involve the incumbent to work in another county or staffing location to assist other State Agencies with emergency work.

Emergency duties may include, but not limited to, responses to or threats involving any disaster or threat of disaster, man-made or natural.

 Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. We offer an excellent array of benefits, including:

•              Health insurance (i.e., individual and family coverage) to eligible employees

•              Life insurance; $25,000 policy is free plus option to purchase additional life insurance

•              Dental, vision and supplemental insurance

•              State of Florida retirement options, including employer contributions

•              Ability to earn up to 176 hours of paid annual leave as a new employee with the State of Florida

•              Ability to earn up to 104 hours of sick leave annually

•              Nine paid holidays and 1 personal holiday each year

•              Opportunities for career advancement

•              Tuition waivers (accepted by major Florida Colleges/universities)

•              Student loan forgiveness opportunities (eligibility required)

•              Training opportunities

•              Flexible Spending Accounts

•              Shared Savings Program for select medical services

•              Lower copays for prescription drugs

•              Health and Wellness discounts

For a more complete list of benefits, please visit https://www.mybenefits.myflorida.com/

KNOWLEDGE, SKILLS, AND ABILITIES

•Federal Medicaid

•Florida Medicaid

•Florida Law Related to Program Integrity

•Federal Law Related to Program Integrity

•Florida Program Integrity Procedure

•Principles of Program Integrity 

•Principles of Investigations

•Theory and Principles of Fraud and Criminology.

•Personnel management and related supervisory techniques.

•Computer software programs such as MS Office.

•General office administration and bureau operations both generally and in detail specific to the assigned unit.

•Ability to travel with or without accommodation.

MINIMUM QUALIFICATIONS REQUIREMENTS

Two years of experience in compliance enforcement, investigative, oversight, regulatory or health care services setting.

Two years of supervisory or managerial experience.

An associate’s degree from an accredited college or university can substitute on a year for year basis in a related field such as health law, health science, health services administration, business administration, public administration, sociology, criminology, or a substantially similar discipline.

Preference will be given to candidates with a program integrity related professional certification, such as: Certified Fraud Examiner; Accredited Healthcare Fraud Investigator; Certified Financial Crimes Investigator; Certified Insurance Fraud Investigator; Certified Compliance and Ethics Professional, or other relevant certification, such as: Project Management Professional

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: HELEN GUNN 850-412-4626

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S.  No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency.  Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement.