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Program Integrity Director Jobs in Illinois (NOW HIRING)

... • Direct contracting strategies with pharmaceutical manufacturers, wholesalers, and GPOs to ... Ensure program integrity through alignment with federal/state regulations and RUSH compliance ...

Coding Integrity Specialist

Chicago, IL · On-site

$42.50 - $45.50/hr

As our Coding Integrity Specialist , you will works with the Coding Integrity Manager and Director ... programs and public reporting * Provide education/feedback to coders/coding managers regarding ...

In addition, the Clinical Director will assist in the planning, delivery, integrity and administration of specified programs in accordance with the stated purpose of the Agency. The Clinical Director ...

Clinical Director

Grayslake, IL · On-site

$90K - $95K/yr

In addition, the Clinical Director will assist in the planning, delivery, integrity and administration of specified programs in accordance with the stated purpose of the Agency. The Clinical Director ...

Clinical Director

Grayslake, IL · On-site

$90K - $95K/yr

In addition, the Clinical Director will assist in the planning, delivery, integrity and administration of specified programs in accordance with the stated purpose of the Agency. The Clinical Director ...

Collaborate with Director of Admissions to ensure adequate, available resources are present in the ... Enters accurate information to support data integrity in computer applications. * Responds ...

Collaborate with Director of Admissions to ensure adequate, available resources are present in the ... Enters accurate information to support data integrity in computer applications. * Responds ...

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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:
AVP Pharmacy Business & Outcomes

AVP Pharmacy Business & Outcomes

Rush

Chicago, IL • On-site

$192K - $286K/yr

Other

Posted 22 days ago


Job description

Location: Chicago, Illinois
Business Unit: Rush Medical Center
Hospital: Rush University Medical Center
Department: System Pharmacy
Work Type: Full Time (Total FTE between 0.9 and 1.0)
Shift: Shift 1
Work Schedule: 8 Hr (8:00:00 AM - 4:00:00 PM)
Rush offers exceptional rewards and benefits learn more at our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits).
Pay Range: $192,150 - $286,312 per year
Rush salaries are determined by many factors including, but not limited to, education, job-related experience and skills, as well as internal equity and industry specific market data. The pay range for each role reflects Rush's anticipated wage or salary reasonably expected to be offered for the position. Offers may vary depending on the circumstances of each case. This role has a corresponding incentive plan based on multiple factors. incentive compensation and additional benefits can be found on our Rush benefits page (https://www.rush.edu/rush-careers/employee-benefits)
Summary:
The Associate Vice President of Pharmacy Business and Outcomes is a key leadership position, reporting to the System Vice President, Chief Pharmacy Officer. The AVP Pharmacy Business & Outcomes provides executive leadership for RUSH's enterprise pharmacy business operations, financial strategy, outcomes analytics, and centralized procurement models. This role ensures the financial sustainability and performance of pharmacy services by unifying contracting, purchasing, 340B optimization, and outcomes measurement within an integrated framework.
The AVP builds and directs system level business and analytic capabilities to assess financial performance, cost savings, market trends, medication access, and the value of pharmacy services across the enterprise. This leader partners closely with site and system leaders to create and execute strategies that strengthen affordability, access, and enterprise wide medication outcomes. Through strategic contracting, disciplined execution, advanced analytics, and collaboration, this executive ensures that RUSH Pharmacy serves as a key driver of financial sustainability, innovation, and measurable system outcomes.
Responsibilities:
Job Responsibilities:
• Provide system level leadership for enterprise pharmacy business operations, including contracting, procurement, and financial performance.
• Create strategies and business models that improve affordability, strengthen medication access, and ensure sustainable growth of RUSH pharmacy services.
• Partner with site pharmacy leaders, finance, supply chain, and clinical executives to align pharmacy business operations with RUSH strategic priorities.
• Partner with system leaders to establish business intelligence and analytics to monitor key financial, operational, and clinical pharmacy impact including metrics of savings, utilization trends, patient medication access and population outcomes.
• Ensure pharmacy performance measurement aligns with enterprise goals including quality, population health, and financial sustainability.
• Lead enterprise relationships with pharmaceutical manufacturers, wholesalers, GPOs, analytics vendors, and technology partners.
• Collaborate to design contracting and utilization strategies that improve affordability and medication access for employees.
• Direct contracting strategies with pharmaceutical manufacturers, wholesalers, and GPOs to secure cost savings, optimize access, and support enterprise initiatives.
• Lead enterprise purchasing strategies that reduce variation, strengthen supply chain resiliency, and leverage scale.
• Implement standardized systemwide processes to reduce variation, improve medication distribution, and strengthen operational reliability.
• Oversee centralized workflows for medication distribution and drug shortage mitigation in close collaboration with site pharmacy leaders and system supply chain partners.
• Lead the enterprise 340B strategy to maximize savings, compliance, patient benefit, and long term program viability.
• Ensure program integrity through alignment with federal/state regulations and RUSH compliance standards.
• Partner to optimize 340B aligned medication access strategies.
• Develop and manage systemwide pharmacy business budgets, forecasts, financial models, and return on investment analytics.
• Identify new revenue opportunities and innovative business models to support long term sustainability and growth.
• Anticipate and respond to market trends in drug pricing, distribution, reimbursement, and supply chain regulation.
• Recruit, mentor, and develop pharmacy business, financial, and analytic leaders across the enterprise.
• Promote a culture of transparency, accountability, data driven decision making, and measurable results.
• Represent RUSH in regional and national forums related to pharmacy business operations, analytics, and procurement.
• Perform all additional duties as assigned or identified as departmental priorities.
Other information:
Required Job Qualifications:
• Minimum of 7 years of progressive leadership experience in pharmacy
• Demonstrated expertise in procurement, contracting, and vendor negotiations with pharmaceutical manufacturers, wholesalers, or group purchasing organizations (GPOs).
• Proven track record of financial management, including budget development, forecasting, ROI analysis, and performance reporting.
• Strong knowledge of healthcare finance and supply chain operations, including logistics and inventory management.
• Demonstrated ability to collaborate effectively with cross-functional leaders
• Experience leading or overseeing 340B program operations, with demonstrated compliance and savings optimization.
Preferred Job Qualifications:
• Education: Master's degree in healthcare administration, business administration (MBA), or related field preferred.
• PharmD or 340B-related certifications (e.g., Apexus Certified Expert (ACE), 340B University).
• Demonstrated success leveraging analytics to drive outcomes.
Physical Demands:
• Prolonged periods of standing, walking, or sitting, with occasional computer work for extended durations.
• May require lifting up to 20 pounds (e.g., inventory handling).
• Work in a high-pressure, fast-paced environment with potential for on-call responsibilities to address urgent operational or clinical issues.
Disclaimer: The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.