About the opportunity

We are seeking an experienced Manager of Data Mining & Review Operations to lead a team responsible for operational execution of data mining and claims review activities within a State Medicaid Recovery Audit Contractor (RAC) environment. This role will oversee day-to-day review operations supporting Medicaid RAC initiatives, ensuring high-quality, compliant, and timely delivery of audit-aligned outputs. The Manager will operate in a vendor delivery model and must be comfortable managing operational performance while collaborating closely with leadership and client stakeholders in a regulated, compliance-driven environment.

The Manager will provide direct supervision, coaching, and performance management for a team of data mining analysts and review specialists focused on Medicaid RAC claim identification and audit support activities. This includes assigning and prioritizing workloads, monitoring productivity and accuracy, maintaining quality control standards, and ensuring team members are well-trained in RAC review protocols, documentation requirements, and state-specific guidelines. The Manager will be responsible for driving consistent operational execution, resolving workflow bottlenecks, reinforcing accountability, and fostering a culture of precision, responsiveness, and continuous improvement.

This role requires strong oversight of Medicaid claims data mining workflows and review operations, including ensuring that review selections align with approved RAC scopes, state requirements, and audit methodologies. The Manager will coordinate closely with analytics, data engineering, quality assurance, and reporting teams to ensure that data mining outputs are accurate, defensible, and aligned with regulatory and contractual obligations. They will ensure proper documentation standards are upheld, findings are review-ready, and operational outputs can withstand state scrutiny.

The Manager will also support budget adherence and operational forecasting for their team. This includes monitoring team capacity, productivity, and cost efficiency; providing input on staffing needs; tracking performance against financial and throughput targets; and recommending workflow or resource adjustments to ensure delivery objectives are met. While not the ultimate budget owner, this individual will be accountable for managing their team’s performance within defined financial parameters and supporting leadership with data-driven operational insights.

What experience you bring

Strong communication and collaboration skills are essential. The Manager will regularly provide operational updates to senior leadership, escalate risks proactively, and collaborate across functional teams to maintain alignment between program goals and execution. This individual must be able to clearly articulate operational performance, identify areas for improvement, and represent their team confidently in internal and external discussions.

State Medicaid RAC experience is required. Candidates must have direct, hands-on experience operating within a State Medicaid Recovery Audit Contractor program, including familiarity with RAC audit scopes, claim review methodologies, provider communication protocols, Commercial healthcare contracts and reimbursement models (Medicare, Medicaid and Commercial Insurance), and regulatory compliance expectations. Experience specifically supporting New York State Medicaid RAC initiatives and audits is strongly preferred and considered ideal, including familiarity with NYS Medicaid policies, OMIG expectations, and state-specific audit and documentation standards. 

The ideal candidate will bring demonstrated success leading operational teams in Medicaid payment integrity, RAC audit support, or related claims review environments. They will possess strong knowledge of Medicaid claims structures, coding frameworks, and data mining techniques used to identify improper payments, along with proven ability to manage deadlines, enforce quality standards, and deliver results in a highly regulated program environment. Experience working in vendor-client delivery models within state Medicaid programs is highly valued.