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Program Integrity Director Jobs in New Mexico (NOW HIRING)

HF Sinclair

Facility Integrity Specialist

Artesia, NM · On-site

... Program and conducts high-level assignments and duties for the Integrity Management Department independently. May direct or lead the work of others from time to time. Job Duties (functions considered ...

HF Sinclair

Facility Integrity Specialist

Artesia, NM

... Program and conducts high-level assignments and duties for the Integrity Management Department independently. May direct or lead the work of others from time to time. Job Duties (functions considered ...

HF Sinclair

Facility Integrity Specialist

Artesia, NM

... Program and conducts high-level assignments and duties for the Integrity Management Department independently. May direct or lead the work of others from time to time. Job Duties (functions considered ...

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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 job categories do people searching Program Integrity Director jobs in New Mexico look for? The top searched job categories for Program Integrity Director jobs in New Mexico are:
What cities in New Mexico are hiring for Program Integrity Director jobs? Cities in New Mexico with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Infographic showing various Program Integrity Director job openings in New Mexico as of June 2026, with employment types broken down into 89% Full Time, and 11% Part Time. Highlights an 100% In-person job distribution.
Program Integrity Coordinator (HCA/MAD #10118671)

Program Integrity Coordinator (HCA/MAD #10118671)

State of New Mexico

Albuquerque, NM • On-site

$26.57 - $39.86/hr

Full-time

Posted 5 days ago

State Of New Mexico rating

7.1

Company rating: 7.1 out of 10

Based on 63 frontline employees who took The Breakroom Quiz

38th of 50 rated states

Job description

$26.57 - $39.86 Hourly
$55,273 - $82,909 Annually
This position is a Pay Band C7
Posting Details
Interviews are anticipated to be conducted within two weeks of closing date.
This job posting may be used to fill multiple vacancies.
Our Vision
  • Every New Mexican has access to affordable health care coverage through a coordinated and seamless health care system.

Our Mission
  • We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

Our Goals
  • Leverage purchasing power and partnerships to create innovative policies and models of comprehensive health care coverage that improve the health and well-being of New Mexicans and the workforce.
  • Achieve health equity by addressing poverty, discrimination, and lack of resources, building a New Mexico where everyone thrives.
  • Implement innovative technology and data-driven decision-making to provide unparalleled, convenient access to services and information.
  • Build the best team in state government by supporting employees continuous growth and wellness.

Why does the job exist?
The Program Integrity Coordinator will:
  • Provide operational and coordination support for Program Integrity activities impacted by HR1 implementation;
  • Support the execution, tracking, and documentation of integrity-related activities to help ensure compliance and accountability;
  • Support oversight efforts and maintain accurate records related to program integrity functions.

How does it get done?
The Program Integrity Coordinator is responsible for:
  • Supporting Program Integrity activities by assisting with coordination, documentation, tracking, and data collection;
  • Supporting preparation of reports, tracking action items, maintaining records, and assisting with communication across eligibility, payments, policy, and systems teams;
  • Ensuring integrity activities are implemented consistently and supporting monitoring and reporting needs;
  • Focusing on duties in the Fee for Service Unit including:
    • Reviewing and processing suspended claims;
    • Maintaining claim notes updated for tracking and auditing purposes;
    • Identifying provider billing issues and referring to FFS Quality for provider training opportunities aligning with HR1;
    • Reviewing and analysis of reports;
    • Conducting research and providing analysis;
    • Creating and updating internal guides and workflows, including policy review, guidance and revisions;
  • Participating in meetings bureau and division wide and any other assigned duties.

Who are the customers?
  • Internal stakeholders across Health Care Authority (HCA) and Medical Assistance Division (MAD), including program integrity staff, eligibility and payments teams, policy partners, and leadership involved in oversight activities.

Ideal Candidate
The Ideal Candidate has experience:
  • Supporting program integrity, compliance, or oversight activities in public-sector programs;
  • Coordinating meetings, tracking action items, and maintaining documentation;
  • Assisting with data collection and monitoring activities;
  • Preparing summaries and basic reports for review;
  • Communicating clearly with internal stakeholders;
  • Working within regulated or compliance-driven environments;
  • Managing assigned tasks in support of oversight and accountability goals;
  • Reviewing reports and claims;
  • Writing, reviewing and implementing processes and policies.

Minimum Qualification
Associate degree in Business Administration, Healthcare Administration, Statistics, Finance, or a related field and two (2) years of experience with a public assistance program, medical, healthcare, educational, or state facility working with policies and procedures, conducting analysis/research, providing or requesting information from the general public, working with communities, working on health or social service related matters, social work/case management, behavioral health, and/or health care. Any combination of education from an accredited college or university in a related field and/or direct experience in this occupation totaling four (4) years may substitute for the required education and experience.
Employment Requirements
Must possess and maintain a valid driver's license.
Must obtain a Defensive driving certification.
Working Conditions
Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT), extensive personal computer and phone usage with extended periods of sitting.
Supplemental Information
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Agency Contact Information: Jolene Jaffa, (505) 690-9920. Email
For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.
Bargaining Unit Position
This position is covered by a collective bargaining agreement and all terms/conditions of that agreement apply and must be adhered to.

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