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Program Integrity Director Jobs in Maine (NOW HIRING)

Policy and Compliance Manager

Augusta, ME ยท Hybrid

$62K - $88K/yr

... Program Integrity and the Attorney General's Healthcare Crimes Unit. Draft Standard Operating ... This includes oversight of the Certified Nursing Assistant and Direct Care Worker Registry ...

Director of Finance

Portland, ME ยท On-site

$90K - $95K/yr

... integrity, credibility, and dedication to the mission of ProsperityME. * Ability to translate ... Excellent experience with financial programs and software including QuickBooks Benefits of the Job:

Director of Finance

Portland, ME ยท On-site

$90K - $95K/yr

... integrity, credibility, and dedication to the mission of ProsperityME. * Ability to translate ... Excellent experience with financial programs and software including QuickBooks Benefits of the Job:

Executive Director

Bath, ME ยท On-site

$65K - $85K/yr

The ED advances the mission through effective program oversight, innovative fundraising, careful ... The successful candidate will embody Habitat's core values of integrity, respect, compassion, and ...

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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.
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What job categories do people searching Program Integrity Director jobs in Maine look for? The top searched job categories for Program Integrity Director jobs in Maine are:
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Brain Injury Services Clinical Director

RiverRidge Outpatient - ME

Kennebunk, ME โ€ข On-site

$150K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 20 days ago


Job description

Overview:

We are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve

Responsibilities:

Are you a visionary clinical leader passionate about redefining the standard of care in brain injury rehabilitation? Then join our team as the Clinical Director Brain Injury Services.  In this role you will champion the integrity of our Brain Injury (BI) program across the entire continuum of care from intensive inpatient rehabilitation to outpatient services.  Collaborating directly with the Medical Director, Nursing Home Administrator, and Vice President of Medical Affairs, you will drive clinical innovation, mentor a multidisciplinary team, and act as our leading community spokesperson and clinical ambassador. If you are ready to combine executive oversight with a deep commitment to cognitive remediation and patient outcomes, we want you on our team.

Key Responsibilities

Clinical Excellence & Program Integrity

Oversee Care Continuum: Direct high-quality inpatient and outpatient neuropsychological treatments, as well as critical cognitive, behavioral, and emotional screenings.

Interdisciplinary Leadership: Represent the BI program at interdisciplinary team meetings (including MDS, nursing, rehab, physiatrists, and families) to report on neuropsychological status and coordinate holistic care.

Policy & Education: Review, approve, and implement cutting-edge patient care policies. Partner with the Nurse Practice Educator to develop comprehensive brain injury training for nursing and ancillary staff.

Operations & Strategic Growth
Operational Oversight: Manage daily operations for outpatient rehabilitative services, including driving productivity, optimizing utilization, and spearheading program growth.

Executive Collaboration: Meet regularly with the Administrator and VPMA to review outpatient financial productivity, identify new business development opportunities, and align the program's scope of services with regional needs.

Steering Committee Leadership: Serve on the Center s Brain Injury Steering Committee alongside the Medical Director and Director of Nursing to synchronize inpatient, residential, and outpatient care.

People Leadership & Mentorship

Direct Supervision: Provide administrative and programmatic direction to a dedicated team, including the Assistant Director of BI Services, skilled outpatient therapists (PT, OT, SLP), case managers, recreational therapists, social workers, and rehab technicians.

Medical Mentorship: Serve as a trusted educator and mentor to center physicians, nurse practitioners, and physician assistants. 

Compliance & Community Ambassadorship

Regulatory Leadership: Ensure rigid compliance with federal, state, and CARF regulatory requirements; actively lead the team through the survey process and monthly Quality Improvement (QI) initiatives.

Clinical Ambassador: Act as the face of the program to the broader medical community. Establish strong, collaborative relationships with regional hospitals, physician groups, and community practitioners through educational and promotional marketing.

Qualifications:

*Graduate of an accredited college or university with a Doctorate in Psychology.

*Five years of direct experience (in respective discipline) with patients with brain injuries.

*State licensure as a licensed Clinical Psychologist.

Benefits:

*Variable compensation plans

*Tuition, Travel, and Wireless Service Discounts

*Employee Assistance Program to support mental health

*Employee Foundation to financially assist through unforeseen hardships

*Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off

*Free 24/7 virtual health care provided by licensed doctors for all Anthem medically enrolled employees and their immediate family members

*On-Demand Pay Program that allows for instant access to a portion of the money you ve already earned
 
We also offer several voluntary insurances such as:
*Pet Insurance
*Term and Whole Life Insurance
*Short-term Disability
*Hospital Indemnity
*Personal Accident
*Critical Illness
*Cancer Coverage

Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service.

Posted Salary Range: USD $90.00 - USD $150,000.00 /Yr.