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Program Integrity Director Jobs in Maine (NOW HIRING)

Northern Light Health

$43.46 - $67.15/hr

... programs and benefits. Northern Light Mayo Hospital Department: Medical Surgical Unit Position is ... Behaves with Integrity and Builds Trust: Acts consistently in line with the core values ...

HP Hood

Director, Human Resources

Portland, ME · Remote

$180K - $200K/yr

Our culture is built on value commitments to innovation, quality, results, integrity, community ... We offer a competitive benefits package that includes health, dental, vision, wellness programs ...

DaVita

Director of Operations

West Poland, ME

Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun ... Professional development programs: DaVita offers a variety of programs to help strong performers ...

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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 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 popular job titles related to Program Integrity Director jobs in Maine? For Program Integrity Director jobs in Maine, the most frequently searched job titles are:
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:
What cities in Maine are hiring for Program Integrity Director jobs? Cities in Maine with the most Program Integrity Director job openings:
Program Integrity Director jobs near you

Dir- Nursing

Northern Light Health

On-site

$43.46 - $67.15/hr

Full-time

Re-posted 14 days ago

Northern Light Health rating

6.7

Company rating: 6.7 out of 10

Based on 164 frontline employees who took The Breakroom Quiz

533rd of 887 rated healthcare providers

Job description

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.
Northern Light Mayo Hospital
Department: Medical Surgical Unit
Position is located: Mayo Hospital, Dover-Foxcroft, ME
Work Type: Full Time
Hours Per Week: 40 Hour/Week
Work Schedule: 7:00 AM to 4:30 PM
Exempt: Yes
Summary:
The Inpatient Nursing Director is responsible for all operations of the Medical Surgical and Obstetrics (OB) Departments. The Inpatient Nursing Director contributes to the long-term growth and viability of the hospital/Northern Light Health, ensures high-quality, cost-effective patient care, addresses issues of customer satisfaction and human resources management
Responsibilities:
  • Adheres to governmental and industry specific regulations/laws. Maintains current knowledge of organization's policies and procedures.
  • Maintains and safeguards confidentiality of information, including patient, personnel, and organizational data/records.
  • Provides prompt and effective service to internal and external customers.
  • Compiles, analyzes, and interprets data per business needs.
  • Assists with staff education and training as appropriate.
  • Develops budgetary goals and/or is mindful of financial performance targets.
  • Identifies, pursues, and achieves previously established personal, team, and organizational goals.
  • Maintains a safe environment for healthcare workers, patients, and/or visitors complying with Northern Light Health policies and procedures; reviews, documents and addresses all incidents and safety violations within area of responsibility; reports all lost time due to reported work injuries within 24 hours to local HR BP or Safety contact; supports and facilitates open and non-punitive communication among Northern Light Health employees, non-employed healthcare workers, patients and visitors, reporting and addressing patient and environmental safety concerns.
  • Directly leads work efforts of subordinates and/or peers.
  • Attends education sessions, workshops, and other continuing education opportunities to enhance or gain new skills.
  • Contributes to the development of policies and procedures.
  • Develops rapport and strong working relationship with external organizations and communities.
  • Participates in research activities and studies.
  • Actively works to identify, mitigate, and prevent risks.
  • Drafting, refining, implementing, and tracking strategic plans and goals.
  • Leverages software and/or hardware relative to job function.
  • Performs other duties as assigned or required.
  • Communicate effectively in both oral and written form, as appropriate for the needs of the audience.
  • Work with members of the team or department in an effective and efficient manner. Shares knowledge and serves as a resource in a team environment.
  • Reviews paperwork, files, or reports of various departments, vendors, patients, and other staff to ensure integrity of data and adherence to organizational and governmental standards.
  • Manages relationships with vendors at level commensurate with position.
  • Provides community benefits through involvement and engagement with outside organization and events.
  • Ensures all functions related to customer service supports the department, member organization, and patient related goals.
  • Engages in various operational responsibilities to support department and organization.
  • Integrates management and delivery of comprehensive healthcare services.
  • Cleans assigned areas and/or equipment. May include trash removal, disinfecting of clinical and non-clinical areas.
  • Performs tasks of a clinical nature within scope of assigned duties and clinical expertise.
  • Records, maintains, distributes, and prepares documents or information.
  • Manages / maintains electronic health records in accordance with confidentiality standards and policies.
  • Demonstrates and applies understanding of equipment's usage and maintenance relative to job function.
  • Performs general office tasks associated with the operations of department and/or organization.
  • Follows established procedures and standards to limit the spread of infection.
  • Manages inventory, which may include re-stocking, back ordering, purchasing, and returning.
  • Attends and participates in meetings.
  • Researches, identifies, and/or purchases items pertinent to the position.
  • Works towards established performance indicators consistently.
  • Provides logistic, financial, emotional support and guidance to patients.
  • Works to meet patient's psychological, emotional, or physical needs.
  • Identifies and advocates for improvement to processes within the department and organization when identified.
  • Coordinates, drives, and tracks key projects as assigned.
  • Performs tasks according to established guidelines to ensure quality goals and standards are met.
  • Understands and follows QC policies and procedures. Verifies that the proper QC is performed before reporting patient results. Correctly prepares QC material. Performs, interprets and documents QC. Understands and documents QC corrective action.
  • Creates and disseminates reports to appropriate personnel.
  • Other job duties as assigned.

Other Information:
Competencies and Skills
  • Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
  • Arithmetic
  • Electronic medical record software.
  • Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
  • Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
  • Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.
  • Human Capital, Supply Chain and Financial Software.
  • Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
  • Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
  • Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.
  • MS Teams
  • Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
  • Promotes Health and Safety: Promotes a healthy and safe environment for patients, employees and visitors. Advocates and models healthy physical and mental health behaviors even in challenging circumstances. Sets high quality standards and strives for continuous improvement and quality assurance by reporting and encouraging others to report near misses and safety issues.
  • Provides Patient-Centered Care: Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results. Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account. Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.
  • Public Speaking
  • Seeks Process Improvement & Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.
  • Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.
  • Zoom
  • Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
  • Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
  • Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
  • Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.
  • Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
  • Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
  • Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.
  • Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability .

Credentials
  • Required Registered Nurse

Education
  • Required Bachelor's Degree

Required Experience
  • 5 year/years of Clinical Experience

Working Conditions
  • Potential exposure to abusive and/or aggressive people.
  • Potential exposure to diseases or infections.
  • Potential exposure to hazardous materials.
  • Potential exposure to noise levels being uncomfortable.
  • Potential exposure to noxious odors.
  • Work with computers, typing, reading or writing.
  • Work beyond the regularly scheduled hours.
  • Extend body and limbs to reach items.
  • Lifting, moving and loading 20 to 30 pounds.
  • Prolonged periods of sitting.
  • Alternate shift schedules (day, evening, nights, weekends).
  • Prolonged periods of standing.
  • Prolonged periods of walking.

Questions? Contact Talent Acquisition:
phone: 207-973-7100
email: talentacquisition@northernlight.org
Dover- Foxcroft, Maine, NL Mayo, Critical Access Hospital (CAH) Rural Health Care

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