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Program Integrity Director Jobs in Illinois (NOW HIRING)

TOUCHETTE

Outpatient Manager

East Saint Louis, IL · On-site

Monitors program integrity through the appropriate staff credential and educational competencies ... Submits quality improvement data to Director on a monthly basis. * Possess knowledge of various ...

CVR ASSOCIATES INC

HCV Program Director

Chicago, IL · On-site

CVR is committed to fostering a culture of teamwork and integrity. We seek to hire individuals who ... The Director is accountable for program outcomes, operational effectiveness, and delivery of high ...

TOUCHETTE

Outpatient Manager

East Saint Louis, IL · On-site

$44.08 - $58.68/hr

Monitors program integrity through the appropriate staff credential and educational competencies ... Submits quality improvement data to Director on a monthly basis. * Possess knowledge of various ...

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Program Integrity Director information

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 Program Integrity Directors?

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 popular job titles related to Program Integrity Director jobs in Illinois? For Program Integrity Director jobs in Illinois, the most frequently searched job titles are:
What job categories do people searching Program Integrity Director jobs in Illinois look for? The top searched job categories for Program Integrity Director jobs in Illinois are:
What cities in Illinois are hiring for Program Integrity Director jobs? Cities in Illinois with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Director of Risk Management and Compliance

Director of Risk Management and Compliance

Christian Community Health Center

Chicago, IL • On-site

$80K - $85K/yr

Full-time

Medical, Dental, Vision, Life

Posted 2 days ago

Job description

Job Title
Director of Risk Management and Compliance

Reports To:
Chief Operations Officer
FLSA Status:
Exempt

POSITION SUMMARY
The Compliance amp; Risk Manager is responsible for supporting the development, implementation, and ongoing oversight of the CCHC’s Compliance Program and Enterprise Risk Management (ERM) framework. This position ensures adherence to federal and state regulations—including HRSA, CMS, FTCA, HIPAA, OSHA, 340B, Medicaid/Medicare billing requirements—and proactively identifies and mitigates organizational risks.
The Compliance amp; Risk Manager partners closely with clinical, operational, finance, pharmacy, and administrative departments to ensure policies, procedures, performance improvement, and quality initiatives are aligned with HRSA compliance, industry best practices, and organizational goals.

KEY RESPONSIBILITIES
1. Compliance Program Oversight
  • Support administration of the organization’s Corporate Compliance Program in accordance with HRSA’s requirements, Federal Sentencing Guidelines, and OIG Compliance Program Guidance.
  • Conduct routine audits and compliance reviews of operational, clinical, financial, and billing functions.
  • Help develop and maintain policies and procedures addressing compliance, regulatory, privacy, and risk matters.
  • Coordinate the annual HRSA Operational Site Visit (OSV) preparation, monitoring, and corrective action plans.
  • Monitor regulatory updates and communicate changes to leadership and staff.
2. Risk Management amp; Regulatory Readiness
  • Support the organization’s Enterprise Risk Management (ERM) process, including risk identification, risk scoring, mitigation planning, and tracking.
  • Conduct Root Cause Analyses (RCA) and implement corrective actions for adverse events, near misses, or compliance concerns.
  • Maintain incident reporting processes and track trends.
  • Serve as liaison for insurance carriers, including liability, property, workers’ compensation, and FTCA requirements.
  • Assist with emergency preparedness compliance, OSHA oversight, and Environment of Care coordination.
3. HIPAA Privacy amp; Security Compliance
  • Participate in monitoring compliance with HIPAA Privacy, Security, and Breach Notification Rules.
  • Investigate privacy incidents and potential breaches; develop corrective action plans.
  • Conduct annual HIPAA training and workforce education.
  • Collaborate with IT to ensure alignment with information security policies and safeguards.
4. 340B Program Oversight (as applicable)
  • Assist with compliance monitoring of the 340B Drug Pricing Program in collaboration with pharmacy leadership.
  • Support internal audits for 340B eligible encounters, prescription validation, contract pharmacy oversight, diversion, and duplicate discount prevention.
  • Maintain documentation required for HRSA 340B audits and program integrity monitoring.
5. Internal Audits amp; Monitoring
  • Develop, schedule, and perform compliance and risk audits, including:
  • Billing and coding
  • Eligibility and sliding fee scale
  • Documentation standards
  • Credentialing compliance
  • Referral and care coordination documentation
  • Quality improvement program alignment
  • Prepare audit reports and present findings to leadership.
6. Training, Education amp; Communication
  • Conduct compliance, HIPAA, regulatory, and risk management training for new hires and current staff.
  • Provide coaching and support to leaders on compliance-related questions.
  • Maintain communication tools such as newsletters, alerts, intranet posts, and compliance dashboards.

7. Investigations
  • Conduct internal compliance investigations, including interviewing staff, reviewing documentation, and analyzing findings.
  • Document outcomes and ensure appropriate corrective or disciplinary actions are implemented.
8. Corporate Governance Support
  • Support the compliance committee and quality/risk committees.
  • Assist with board reporting, annual risk assessments, and organizational compliance metrics.
Maintain documentation necessary for HRSA Section 330-related compliance elements.

QUALIFICATIONS
  • Masters degree in Health Administration, Public Health, Nursing, Business, or related field required,
  • Minimum 3–5 years of experience in healthcare compliance, risk management, quality improvement, or regulatory operations (FQHC preferred).
  • Knowledge of HRSA, FTCA, CMS, Medicaid/Medicare, HIPAA, OSHA, and 340B program requirements.
  • Certification preferred (one or more):
  • CHC (Certified in Healthcare Compliance)
  • CCEP (Certified Compliance and Ethics Professional)
  • CPHRM (Certified Professional in Healthcare Risk Management)
  • CPPS (Patient Safety)
  • CHPC (HIPAA Privacy Certified)

KEY COMPETENCIES
  • Strong understanding of FQHC regulatory and compliance frameworks
  • Ability to conduct audits, analyze findings, and drive corrective action
  • Knowledge of healthcare billing, coding, eligibility, and reimbursement processes
  • Excellent communication, training, and investigation skills
  • Strong analytical, organizational, and project management abilities
  • Ability to collaborate effectively with clinical and administrative leaders
  • High integrity, discretion, and sound judgment
Employee Benefits offered to Fulltime Staff
  • Blue Cross Blue Shield Medical Insurance
  • Blue Cross Blue Shield Dental and Vision Insurance
  • Supplemental Benefits
  • Life Insurance (Provided by the company)

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