Posting Details Interviews are anticipated to be conducted within two weeks of closing date. This job posting may be used to fill multiple vacancies. The Health Care Authority (HCA) participates in E-Verify and will verify employment eligibility upon hire. Our Vision Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system. Our Mission We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services. Our Goals Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce. Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives. Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information. Build the best team in state government by supporting employees continuous growth and wellness. Why does the job exist? The Compliance and Program Integrity Assistant Deputy Director will: Provide strategic leadership, statewide coordination, and specialized expertise to ensure the integrity, accountability, and transparency of all publicly funded healthcare programs; Proactively identify, prevent, and mitigate Fraud, Waste and Abuse (FWA), operational vulnerabilities, and risks to public resources through data analytics, monitoring, cross-agency collaboration, and implementation of statewide Program Integrity (PI) standards; Establish clear leadership over Program Integrity activities across all Medicaid programs, fee-for-service, managed care, specialty programs, and vendor operations ensuring the department meets federal and state program integrity expectations and maintains strong stewardship of Medicaid funds. How does it get done? The Compliance and Program Integrity Assistant Deputy Director is responsible for:

Strategic Program Governance:

Establishing and executing long-term operational roadmaps to safeguard public healthcare expenditures; Defining measurable performance benchmarks, risk-based oversight frameworks, and strategic priorities aligned with state policies and federal Centers for Medicare and Medicaid Services (CMS) standards.

Advanced Data Analytics and Vulnerability Identification:

Leveraging sophisticated claims monitoring, algorithmic trend analysis, and predictive data modeling to detect billing anomalies, pattern irregularities, and high-risk provider or Managed Care Organization (MCO) behaviors across all Medicaid delivery systems.

Cross-Agency Enforcement and Law Enforcement Liaison:

Serving as the primary executive contact for external oversight and law enforcement partners, including the New Mexico Department of Justice Medicaid Fraud Control Unit (NM

DOJ MFCU

), Health and Human Services (HHS), Office of Inspector General (OIG), and federal agencies; Coordinating formal investigations, managing information requests, and ensuring all agency responses meet strict legal and regulatory standards.

Targeted Audits, Monitoring and Corrective Action:

Oversight of comprehensive audit workflows, field reviews, and compliance monitoring for contracted MCOs, vendors, and healthcare providers; Mandating robust Corrective Action Plans (CAPs), tracking remediation efforts, and maintaining defensible administrative audit trails.

Policy Formulation and Executive Reporting:

Authorizing authoritative reporting for legislative committees, executive leadership, and federal oversight authorities; Evaluating existing statutes, administrative rules, and contract provisions to recommend policy updates that close systemic vulnerabilities while maintaining transparency.

Team Leadership and Division Development:

Leading, mentoring, and directing a specialized team of compliance specialists, surveyors, and analysts; Delivering technical guidance across agency divisions and MCO partners to embed a culture of continuous risk management, analytical precision, and fiscal integrity. Who are the customers? New Mexico Medicaid members; Health Care Authority (HCA), Medical Assistance Division (MAD) Executive Leadership, Cabinet Secretary, state legislative bodies and federal oversight entities; Centers for Medicare and Medicaid Services (CMS), Center for Program Integrity (CPI), Government Accountability Office (GAO), Health and Human Services (HHS) and Office of Inspector General (OIG); State and federal law enforcement partners, New Mexico Department of Justice Medicaid Fraud Control Unit (MFCU), contracted Managed Care Organizations (MCOs), contractors, and healthcare providers statewide. Ideal Candidate New Mexico Medicaid members; Health Care Authority (HCA), Medical Assistance Division (MAD) Executive Leadership, Cabinet Secretary, state legislative bodies and federal oversight entities; Centers for Medicare and Medicaid Services (CMS), Center for Program Integrity (CPI), Government Accountability Office (GAO), Health and Human Services (HHS) and Office of Inspector General (OIG); State and federal law enforcement partners, New Mexico Department of Justice Medicaid Fraud Control Unit (MFCU), contracted Managed Care Organizations (MCOs), contractors, and healthcare providers statewide. Minimum Qualification Bachelor's Degree in a relevant field of study from an accredited college or university and ten (10) years of professional level experience with a tactical impact directly related to the purpose of the position defined by the agency at the time of recruitment. Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling fourteen (14) years may substitute for the required education and experience. Employment Requirements Must possess and maintain a valid Driver's License. Must obtain a Defensive Driving certification. Working Conditions Work is performed in an office setting with extensive personal computer and telephone use. Statewide travel required. Supplemental Information Do you know what Total Compensation is? Click here

Agency Contact Information:

Jolene Jaffa, (505) 690-9920. Email For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement. Bargaining Unit Position This position is not covered by a collective bargaining agreement.