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Program Integrity Director Jobs in Florida (NOW HIRING)

UF Health

Director Clinical Document Integrity

Gainesville, FL · On-site

$31.50 - $42.50/hr

Overview The Director of Clinical Documentation Integrity (CDI) provides enterprise-wide leadership ... This leader is accountable for operating a consistent CDI program that improves documentation ...

New

UF Health

Director Clinical Document Integrity

Gainesville, FL · On-site

$31.50 - $42.50/hr

Overview The Director of Clinical Documentation Integrity (CDI) provides enterprise-wide leadership ... This leader is accountable for operating a consistent CDI program that improves documentation ...

New

Boys and Girls Clubs of Palm Beach County, Inc.

Be Seen First

Assistant Club Director

West Palm Beach, FL · On-site

$58K - $60K/yr

... and delivery, maintains program integrity, helps meet grant objectives, fosters positive ... Provide direct supervision to Athletic Coordinators, Wellbeing and Life Skills Coordinators ...

V2X

Program Executive Director

Melbourne, FL · On-site

... with integrity, respect, responsibility, and professionalism. V2X invites applications for the ... Direct enterprise-level DOS INL/A aviation operations and maintenance programs across deployed ...

V2X

Program Executive Director

Melbourne, FL · On-site

... with integrity, respect, responsibility, and professionalism. V2X invites applications for the ... Direct enterprise-level DOS INL/A aviation operations and maintenance programs across deployed ...

V2X

Program Deputy Director

Melbourne, FL · On-site

$108K/yr

... with integrity, respect, responsibility, and professionalism. V2X invites applications for the ... of Program Deputy Director for the U.S. Department of State (DoS) Bureau for International ...

V2X

Program Deputy Director

Melbourne, FL · On-site

$108K/yr

... with integrity, respect, responsibility, and professionalism. V2X invites applications for the ... of Program Deputy Director for the U.S. Department of State (DoS) Bureau for International ...

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Program Integrity Director information

What is a program integrity director?

Program Integrity Directors are responsible for overseeing and ensuring the compliance, effectiveness, and accountability of organizational programs, often within government agencies or large organizations. They develop and implement policies to prevent fraud, waste, and abuse, and they monitor program operations to ensure adherence to regulations and standards. Program Integrity Directors often lead teams, conduct audits, and collaborate with other departments to promote transparency and ethical practices. Their work is crucial for maintaining public trust and ensuring resources are used appropriately.

What are some typical challenges faced by a program integrity director, and how can they be addressed?

Program Integrity Directors often face challenges such as navigating complex regulatory requirements, detecting and preventing fraud, and ensuring compliance across multiple departments or partners. Addressing these requires strong analytical skills, clear communication, and effective collaboration with legal, compliance, and operational teams. Staying updated on industry best practices and fostering a culture of transparency can also help mitigate risks and support program goals.

What are the key skills and qualifications needed to thrive as a program integrity director, and why are they important?

To thrive as a Program Integrity Director, you need expertise in compliance, risk management, regulatory analysis, and a relevant degree such as in business administration, public policy, or law. Familiarity with data analytics tools, case management systems, and certifications like Certified Fraud Examiner (CFE) or Certified Internal Auditor (CIA) are often important. Strong leadership, ethical judgment, and effective communication skills are crucial for building trust and guiding teams through complex investigations. These skills ensure the organization maintains regulatory compliance, prevents fraud, and promotes operational transparency.

What is the difference between Program Integrity Director vs Claims Manager?

AspectProgram Integrity DirectorClaims Manager
Required CredentialsBachelor's degree, certifications in healthcare compliance or auditingBachelor's degree, experience in claims processing or insurance
Work EnvironmentHealthcare or insurance organizations, compliance departmentsInsurance companies, healthcare payers, claims processing units
Employer & Industry UsageUsed in healthcare, government programs, insurance sectorsPrimarily in insurance companies and healthcare payers

The Program Integrity Director focuses on ensuring compliance, preventing fraud, and maintaining program integrity within healthcare or insurance organizations. In contrast, Claims Managers oversee the processing and adjudication of insurance claims. While both roles require knowledge of healthcare or insurance operations, the Program Integrity Director emphasizes compliance and fraud prevention, whereas the Claims Manager concentrates on claims processing efficiency and accuracy.

What are popular job titles related to Program Integrity Director jobs in Florida?

For Program Integrity Director jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Program Integrity Director jobs in Florida look for?

The top searched job categories for Program Integrity Director jobs in Florida are:

What cities in Florida are hiring for Program Integrity Director jobs?

Cities in Florida with the most Program Integrity Director job openings:

Program Integrity Director jobs near you

Director Clinical Document Integrity

UF Health

Gainesville, FL • On-site

$31.50 - $42.50/hr

Full-time

Posted 2 days ago

New

Job description

Overview

The Director of Clinical Documentation Integrity (CDI) provides enterprise-wide leadership for inpatient and ambulatory documentation integrity, including compliant query practices, standardized CDI workflows, and governance in partnership with Coding, Utilization Management (UM), Quality, and Compliance. This leader is accountable for operating a consistent CDI program that improves documentation quality, supports appropriate severity and risk capture (Medicare Severity Diagnosis-Related Groups (MS-DRGS) and Hierarchical Condition Categories (HCCs)), strengthens Case Mix Index (CMI) and audit defensibility, and reduces documentation-driven denials and rework. The Director partners with physicians, service line leaders, Case Management, and Revenue Cycle/Analytics teams to drive provider engagement, performance reporting, and enterprise-wide standardization.


Qualifications

Education

  • Bachelor’s degree required (BSN)
  • Master’s preferred (in a related field)

 

Experience

  • Minimum of 5 to 7 years of progressive, direct experience as a CDI Specialist
  • Minimum of 3 to 4 years of managerial, supervisory, or director-level experience, ideally within a large academic medical center or a complex medical hospital with proven team and talent development

License/Certification/Registration

  • CCDS (required)
  • RN (Active)
  • CCDS-O (preferred)
  • CCS (preferred)
  • CDIP (preferred)
  • CDEO (preferred)
  • CDEI (preferred)
  • CRCR (preferred)

 

Other Qualifications

  • Cross-functional collaboration and conflict navigation
  • Change leadership with continuous improvement mindset
  • Executive-ready communication (written, verbal, facilitation)
  • Strengthen influencing without authority in a matrixed health system environment
  • Deep knowledge of Clinical Documentation Integrity (CDI) best practices and compliant query standards
  • Comprehensive mastery of coding and DRG assignments, including both MS-DRG and APR-DRG methodologies and expertise in inpatient CDI workflows
  • Strong reimbursement and coding acumen, including ICD-10-CM/PCS, Medicare Severity Diagnosis-Related Groups (MS-DRGs), and Case Mix Index (CMI) drivers
  • Working knowledge of ambulatory documentation priorities, including E/M level selection and risk adjustment mechanisms such as Hierarchical Condition Categories (HCC) and risk capture
  • The ability to impact and interpret hospital quality scores
  • Practical working experience with Epic, combined with Iodine and Interact
  • Ability to act as a trusted advisor to clinical departments and academic faculty, successfully coaching busy physicians and residents on compliant documentation
  • Proven success in establishing a Center of Excellence by partnering with HIM and coding leadership to align training and quality assurance
  • Documentation risk and audit-readiness knowledge, including denial themes and defensibility expectations
  • Advanced analytical capability in trend analysis, root-cause thinking, and performance metric development/interpretation

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