Director Medicaid Fraud Division

Director Medicaid Fraud Division

New Jersey Office of the State Comptroller

Unclassified Division Director

Eligible for remote work up to 2 days per week

Salary Range: M98 - $160,000-190,000

Opening Date: April 6, 2026 | Closing Date: May 3, 2026

Posting # 16-26

About the Office:

The Office of the State Comptroller (OSC) is an independent state agency created to bring greater efficiency and transparency to all levels of New Jersey government. Our mission is to make the government in New Jersey more efficient, transparent, and accountable. Our office audits and investigates municipalities, school districts, counties, state colleges and universities, independent state authorities, and state agencies. We also oversee government expenditures, review public contracts, evaluate local and state programs, and oversee the integrity of New Jersey’s Medicaid program. We detect and uncover fraud, waste, and abuse and share our findings through public reports.

About the Division:

The Medicaid Fraud Division (MFD) oversees New Jersey’s Medicaid program. The Division works to improve the efficiency and integrity of Medicaid in New Jersey and returns millions of dollars to taxpayers each month. The Division consists of the following units: Audit, Data and Fiscal, Investigations, Regulatory and Exclusions, Statistics, and Third-Party Liability (TPL). MFD audits, investigates and reviews healthcare providers, recipients, and managed care organizations (MCOs) that coordinate the provision of an individual’s health care needs. MFD also evaluates the care provided to Medicaid recipients, and works to prevent, detect, and recover overpayments attributable to fraud, waste, and abuse in the program. In addition, MFD pursues civil and administrative enforcement actions and disqualifies providers from participating in the Medicaid program when necessary.

About the Role:

OSC seeks an experienced legal professional with extensive experience in government operations, the Medicaid Program, and New Jersey’s regulatory environment. This individual will oversee the prevention, detection and investigation of fraud, waste, and abuse of funds expended by New Jersey’s Medicaid, Family Care, and Charity Care programs. This position directs a staff of attorneys, data miners, investigators, analysts, auditors, statisticians, and paraprofessionals who conduct investigations, audits, recovery actions, and civil/administrative enforcement proceedings.

Responsibilities:

• Provide executive leadership and decision-making authority for MFD’s strategic direction, organizational priorities, budget and resource allocation, and operational effectiveness, ensuring alignment with institutional goals and driving measurable outcomes.

• Direct collaboration and coordination with Federal and State agencies, including the Division of Medical Assistance and Health Services in the Department of Human Services, MCOs, and the Medicaid Fraud Control Unit in the New Jersey Office of the Attorney General.

• Oversee the recovery of improperly expended Medicaid funds, and the exclusion or termination of providers from the Medicaid program when warranted.

• Deliver authoritative and legal guidance and coordinate inter-agency education outreach to Medicaid providers on complex policy, regulatory, and compliance matters affecting the Medicaid program.

• Ensure accountability by drafting recommendations to improve program integrity, monitoring the implementation of MFD recommendations across public and private entities, and directing corrective action when necessary.

• Direct the preparation and review of well-supported and accurate legal documents, investigative and audit plans, enforcement actions, agreements, and comprehensive reports that identify provider specific and/or systemic issues and, as appropriate, recommend solutions.

• Lead strategic process improvements to enhance operational efficiency, investigative effectiveness, and program integrity.

• Draft comprehensive reports detailing procedures, findings, and corrective action recommendations.

• Maintain comprehensive knowledge of MFD operations and emerging issues to effectively represent the organization in high-level meetings, responses to inquiries, and guidance to executive leadership.

• Foster collaboration across all divisions, state agencies, and with external stakeholders, including healthcare industry representatives.

• Ensure that MFD properly tracks and reports internally and externally legally required information, including overpayment and TPL recoveries.

• Ensure that MFD properly implements legally required oversight activities, including high-risk provider reviews and federal program integrity documentation reviews.

• Oversee legal research, policy development, and regulatory drafting to ensure MFD procedures align with statutory and regulatory requirements.

• Direct oversight and enforcement of TPL payment and recovery contracts.

Requirements:

• Juris Doctor (J.D.) Degree from an accredited law school.

• Membership in the New Jersey Bar in good standing.

• Minimum of twelve years of progressive legal experience in healthcare law, regulatory compliance, fraud investigation, or government enforcement, including at least five years in a senior management or executive leadership capacity.

• Minimum of five years of substantive experience with Medicaid program operations, regulations, compliance, or fraud detection and prevention.

• Demonstrated experience managing large, multi-disciplinary teams and complex investigations or enforcement actions.

The ideal candidate will have the following skills and experience:

• Experience with healthcare fraud prosecution or civil enforcement.

• Knowledge of New Jersey Medicaid regulations and state administrative procedures.

• Experience collaborating with federal agencies.

• Prior experience in a Comptroller, Inspector General, or Attorney General’s office, or at the U.S. Department of Justice.

• Excellent verbal and written communication skills, with the ability to convey complex concepts clearly.

• Adept at multi-tasking, delegating, handling multiple projects, and prioritizing competing deadlines.

• Excellent writing and legal research skills.

• Demonstrated interest in government oversight, accountability and transparency.

Interested candidates should submit a cover letter, resume, writing sample, and three references to:

Shama Nix

Office of the State Comptroller

P.O. Box 024

Trenton, NJ 08625

Email: careers@osc.nj.gov

NOTE:

In accordance with N.J.S.A. 52:15C-5, OSC employees and personnel shall be deemed confidential employees and shall serve in the unclassified service of the Civil Service. Residency Requirements - Pursuant to N.J.S.A. 52:14-7 (L. 2011, Chapter 70), also known as the “New Jersey First Act,” all new public employees are required to obtain principal residence in the State of New Jersey within one (1) year of employment.

The Office of the State Comptroller is proud to be an equal opportunity employer. We are committed to providing a work environment that supports, inspires, and respects all individuals and in which personnel processes are based on merit, performance, and business needs. We do not discriminate on the basis of race, religion, color, national or ethnic origin, gender, sexual orientation, gender identity, gender expression, familial status, citizenship, age, or status as an individual with a disability. We believe that diversity and inclusion among our staff is critical to our success. We seek to recruit, develop and retain the most talented people from a diverse candidate pool and encourage applicants from all backgrounds and experiences to apply.

SAME Applicants:

If you are applying under the “NJ SAME” program, your supporting documents (Schedule A or B letter), must be submitted along with your resume. For more information on the SAME Program visit their website at https://nj.gov/csc/same/overview/index.shtml , email: SAME@csc.nj.gov, or call CSC at (833) 691-0404.