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Medicaid Program Integrity Jobs in Georgia (NOW HIRING)

Enlace Health

Senior Medical Economics Analyst

Atlanta, GA

$84K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Our culture is founded upon integrity, hard work, and the relentless pursuit to make a difference ... Own development of methodologies for program evaluation, performance normalization, and predictive ...

Enlace Health

Senior Medical Economics Analyst

Atlanta, GA · On-site

$84K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

Our culture is founded upon integrity, hard work, and the relentless pursuit to make a difference ... Own development of methodologies for program evaluation, performance normalization, and predictive ...

BRISTOL HOSPICE LLC

Business Office Specialist

Watkinsville, GA

$20 - $22/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Integrity: We are honest and professional. * Trust: We count on each other. * Excellence: We strive ... Advanced training programs * Passionate company culture committed to the highest standard of care ...

Visiting Nurse Health System

Physical Therapist - Atlanta

Atlanta, GA · On-site

$1.6K - $2.0K/wk

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Respect & Integrity - We practice the highest ethical standards and honor our commitments. We are ... Comply with Medicare, Medicaid, and insurance regulations * Drive to patient homes and work ...

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All JobsMedicaid Program Integrity JobsMedicaid Program Integrity Jobs in Georgia

Medicaid Program Integrity information

What is the difference between Medicaid Program Integrity vs Medicaid Claims Examiner?

AspectMedicaid Program IntegrityMedicaid Claims Examiner
Primary FocusDetecting and preventing fraud, waste, and abuse in Medicaid programsReviewing and processing Medicaid claims for accuracy and compliance
Required CredentialsTypically healthcare or compliance certifications, knowledge of Medicaid policiesHealthcare or claims processing certifications, attention to detail
Work EnvironmentRegulatory agencies, government offices, compliance departmentsInsurance companies, healthcare providers, government Medicaid offices

Medicaid Program Integrity professionals focus on safeguarding Medicaid funds by identifying fraudulent activities, while Medicaid Claims Examiners primarily verify claims for accuracy and proper coding. Both roles require healthcare knowledge and certifications but differ in their core responsibilities and work settings.

How do I become a Medicaid Program Integrity specialist?

To become a Medicaid Program Integrity specialist, candidates typically need a bachelor's degree in health administration, public health, or a related field, along with experience in healthcare compliance or auditing. Relevant skills include knowledge of Medicaid policies, data analysis, and investigative techniques, and some roles may require certification such as Certified Fraud Examiner (CFE).

What are popular job titles related to Medicaid Program Integrity jobs in Georgia?

For Medicaid Program Integrity jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Medicaid Program Integrity jobs in Georgia look for?

The top searched job categories for Medicaid Program Integrity jobs in Georgia are:

What cities in Georgia are hiring for Medicaid Program Integrity jobs?

Cities in Georgia with the most Medicaid Program Integrity job openings:

Medicaid Program Integrity jobs near you
Infographic showing various Medicaid Program Integrity job openings in Georgia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 40% In-person, and 60% Remote job distribution.

Registered Nurse (RN) - Multi-Program Clinical Services

Positive Care

Stockbridge, GA • On-site

Full-time

Re-posted 20 days ago

Job description

Company Description
Positive Care's is nonprofit organization 501c3 our corporate office is located in Stockbridge, Georgia. The company has existed for nearly two decades and has experienced increased growth year after year. We operate three separate service programs serving individuals with developmental disabilities, veterans, and housing and stabilization programs. At our foundation, we are a company that thrives off three essential pillars: Compassion, Integrity, Loyalty, and Commitment.
We pride ourselves on providing a culture for our employees to thrive and meet their personal and professional goals. Our employees are allowed to demonstrate their leadership qualities and ingenuity.
Job Description
The Registered Nurse (RN) provides clinical oversight, nursing services, health education, care coordination, and wellness support across all organizational programs and service areas. The RN supports individuals served through IDD service programs, housing stabilization programs, supportive services, veteran programs, community outreach initiatives, personal care services, and other community-based programs operated by the organization.
The RN ensures quality client care, regulatory compliance, coordination of medical and behavioral health services, and support for program participants with complex medical and social service needs. This position may provide both direct clinical support and administrative nursing oversight depending on organizational needs.
Essential Duties and Responsibilities
Clinical & Nursing Services
  • Conduct nursing assessments and monitor client health status.
  • Develop, implement, and monitor individualized care plans.
  • Coordinate healthcare services with physicians, hospitals, pharmacies, behavioral health providers, and community agencies.
  • Administer nursing care and health-related services in accordance with state regulations and organizational policies.
  • Monitor medication management, physician orders, and treatment compliance.
  • Respond to medical concerns and assist with crisis intervention when necessary.
  • Provide health education and wellness coaching to clients and families.

Program Support & Coordination
  • Support clinical operations across all organizational programs and service areas.
  • Assist with healthcare-related intake screenings and eligibility reviews.
  • Participate in interdisciplinary case staffing and service coordination meetings.
  • Collaborate with case managers, direct care staff, housing specialists, and leadership to support client outcomes.
  • Support discharge planning, continuity of care, and referral coordination.

Compliance & Documentation
  • Maintain accurate and timely clinical documentation.
  • Ensure compliance with organizational policies, HIPAA requirements, licensing standards, and funding regulations.
  • Assist with quality assurance activities, audits, and compliance monitoring.
  • Participate in program development and implementation of clinical protocols.

Training & Staff Support
  • Provide training and guidance to direct care staff and program personnel.
  • Monitor health and safety standards within program operations.
  • Assist with infection control, incident reporting, and emergency preparedness procedures.
  • Support staff education related to client care, medication assistance, and healthcare coordination.

Community & Outreach Support
  • Participate in community outreach initiatives, wellness events, and healthcare education programs.
  • Support organizational efforts to connect clients to healthcare and supportive resources.
  • Represent the organization professionally with community partners and stakeholders.

Qualifications
Minimum Qualifications
  • Current and active Registered Nurse (RN) license in the State of Georgia.
  • Graduate of an accredited nursing program.
  • Minimum of 2-3 years of nursing experience preferred.
  • Experience in community health, behavioral health, home health, case management, supportive housing, or long-term care preferred.
  • Current CPR certification required.
  • Strong clinical assessment and documentation skills.
  • Ability to work independently and collaboratively across multiple programs and service settings.
  • Valid driver's license and reliable transportation may be required.

Preferred Qualifications
  • Experience working with vulnerable populations including veterans, individuals experiencing homelessness, seniors, or individuals with disabilities.
  • Knowledge of Medicaid, waiver programs, community-based services, and healthcare coordination.
  • Experience with electronic health records, HMIS, Therap, CaseWorthy, or related systems.
  • Supervisory or clinical oversight experience preferred.
  • Bilingual abilities are a plus.

Knowledge, Skills, and Abilities
  • Strong clinical judgment and problem-solving abilities.
  • Excellent communication and interpersonal skills.
  • Ability to manage multiple priorities in a fast-paced environment.
  • Knowledge of healthcare regulations and confidentiality standards.
  • Ability to maintain professional boundaries and trauma-informed care practices.
  • Commitment to person-centered and culturally competent service delivery.

Additional Information
Positive Care Personal Care Homes, Inc. is an Equal Opportunity Employer committed to providing inclusive, equitable, and compassionate services to the communities we serve
All your information will be kept confidential according to EEO guidelines.

Apply