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Program Integrity Director Jobs in Wisconsin (NOW HIRING)

ULINE

Director of Benefits

Milwaukee, WI

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

ULINE

Director of Benefits

Pleasant Prairie, WI

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

ULINE

Director of Benefits

Pleasant Prairie, WI · On-site

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

ULINE

Director of Benefits

Kenosha, WI · On-site

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

ULINE

Director of Benefits

Pleasant Prairie, WI · On-site

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

ULINE

Director of Benefits

Milwaukee, WI · On-site

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

ULINE

Director of Benefits

Kenosha, WI

Director of Benefits Corporate Headquarters 12575 Uline Dr. Pleasant Prairie, WI 53158 Lead and ... Ensure compliance with regulations while supporting reporting, audits and program integrity.

Dormont Manufacturing Co

WI · On-site

... program integrity, and a strong organizational culture. * Oversees and integrates the work of ... The Executive Director is responsible for building high-performing teams, fostering leadership at ...

RHA Health Services, LLC

WI · On-site

Executive Director - Intellectual and Developmental Disabilities (IDD) We are hiring for the role ... program integrity, and a strong organizational culture. * Lead clinical, administrative, and ...

Adult & Teen Challenge

WI · On-site

The Program Director provides leadership and supervision to interns and student affairs staff ... Dependable, teachable, adaptable, and grounded in integrity. Must pass required background ...

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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 Wisconsin? For Program Integrity Director jobs in Wisconsin, the most frequently searched job titles are:
What job categories do people searching Program Integrity Director jobs in Wisconsin look for? The top searched job categories for Program Integrity Director jobs in Wisconsin are:
What cities in Wisconsin are hiring for Program Integrity Director jobs? Cities in Wisconsin with the most Program Integrity Director job openings:
Program Integrity Director jobs near you
Site Inspector - Remote Wisconsin

Site Inspector - Remote Wisconsin

Gainwell Technologies LLC

Milwaukee, WI • On-site

$54K - $77K/yr

Other

Medical, Life, Retirement, PTO

Posted 29 days ago

Gainwell Technologies rating

7.7

Company rating: 7.7 out of 10

Based on 72 frontline employees who took The Breakroom Quiz

116th of 205 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
The Site Inspector is responsible for conducting provider site visits and program integrity reviews in support of Wisconsin Medicaid provider enrollment and revalidation requirements. This role works closely with the Wisconsin Department of Health Services (DHS) Office of Inspector General (OIG) to verify provider operational readiness, validate compliance with CMS requirements, and support efforts to prevent fraud, waste, and abuse within the Medicaid program. Responsibilities include scheduling and conducting site inspections, documenting findings, performing research, and preparing legally defensible documentation related to enrollment actions and compliance reviews.
Your role in our mission
  • Conduct onsite provider inspections to verify operational status, physical location, business signage, and the provider's ability to perform services identified within enrollment applications.
  • Coordinate and schedule site visits with providers, including communication, appointment management, and utilization of virtual meeting technology when appropriate.
  • Capture photographs, complete inspection templates, document findings, and upload supporting documentation into designated systems in accordance with established procedures.
  • Perform enrollment program integrity compliance reviews, including research, analysis, and evaluation of provider information to identify potential compliance concerns.
  • Prepare detailed reports, recommendations, and supporting documentation for enrollment determinations, sanctions, terminations, denials, and administrative review processes.

What we're looking for
  • Two or more years of experience in inspections, auditing, investigations, compliance, healthcare operations, provider relations, program integrity, fraud prevention, or a related field.
  • Experience conducting research, reviewing documentation, gathering information, and preparing detailed written reports while maintaining accuracy and confidentiality.
  • Strong analytical, organizational, problem-solving, and communication skills with the ability to work independently and manage multiple priorities.
  • Experience working with Medicaid, Medicare, healthcare providers, provider enrollment, regulatory compliance, program integrity, or government-sponsored healthcare programs preferred.
  • Proficiency with Microsoft Office applications, documentation systems, databases, virtual meeting platforms, and technology used to support field-based work.

What you should expect in this role
  • Field-based position requiring frequent travel throughout Wisconsin to conduct provider site visits and inspections.
  • Direct interaction with healthcare providers, clinics, agencies, suppliers, and other Medicaid-enrolled organizations.
  • Collaboration with Wisconsin DHS Office of Inspector General (OIG) and Gainwell program integrity and provider enrollment teams.
  • Independent work environment requiring strong time management, scheduling, documentation, and case management skills.
  • Opportunity to make a direct impact on Medicaid program integrity while supporting compliance initiatives that help prevent fraud, waste, and abuse within the healthcare system.

Pipeline Notice: This is a pipeline requisition. Gainwell will be screening and interviewing qualified candidates on an ongoing basis in anticipation of future hiring needs through the month of August.
Candidates who meet the qualifications may be contacted by a member of our Talent Acquisition team to discuss current and future opportunities.
#LI-REMOTE
#LI-JT1
The pay range for this position is $54,300 - $77,500 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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