Program Integrity Director Jobs in Delray Beach, FL

Description
Our client is seeking an experienced Special Investigation Unit (SIU) Manager to oversee fraud, waste, and abuse investigative activities within a healthcare environment. This individual will lead investigative efforts, support compliance initiatives, manage stakeholder relationships, and ensure adherence to state and federal regulations.The ideal candidate will possess strong leadership skills, experience conducting healthcare investigations, and a deep understanding of fraud prevention methodologies. The SIU Manager will collaborate closely with internal teams, participate in statewide meetings, and drive investigative excellence across the organization.Mandatory Requirements:1.Accountable for establishing and maintaining a relationship with AHCA-Medicaid Program Integrity as part of CCP's Medicaid FWA program, including but not limited to attendance at collaborative meetings and responding to AHCA-MPI inquiries.2.Oversee the Managed Care Plan's fraud and abuse detection and prevention efforts and work with Medicaid Program Integrity and the Medicaid Fraud Control Unit.3.Ensures compliance with all state and federal requirements related to FWA and FWA investigations.4.Performs data-mining activities to identify potential cases for investigation.5.Analyzes data as part of the investigative process.6.Performs research to analyze aberrant claims billing and practice patterns.7.Investigates and documents all fraud, waste, and abuse referrals and cases with a focus on thoroughness and attention to detail, quality, timeliness, and cost control.8.Conducts comprehensive interviews with providers, members, and witnesses to obtain information which would be considered admissible under generally accepted criminal and civil rules of evidence.9.Coordinates with subcontractors on investigations, reporting and recovery of FWA.10.Collaborates with Compliance team members as needed on case elements. 11.Prepares and submits investigative reports covering all phases of the investigation.12.Prepares and sends audit findings to providers. 13. Interprets and conveys information to others, including but not limited to regulatory requirements, AHCA and/or Florida Healthy Kids requirements, and provider contract requirements.14. Establishes and maintains liaison with public officials, law enforcement and others to obtain assistance in conducting investigations.15.Other duties as directed based on business needs, department priorities. Nationwide acceptable Fraud, Waste & Abuse certification or willingness to obtain certification.Ability to travel throughout Florida to attend quarterly state meetings (travel expenses covered by the client).
Skills
Healthcare Fraud, Waste & Abuse Investigations, Regulatory Compliance, Claims Analysis & Investigation, Fraud, Compliance, Process Improvement, Data Analysis & Reporting, Vendor Management, Employee Development & Coaching, Cross-Functional Collaboration
Top Skills Details
Healthcare Fraud, Waste & Abuse Investigations,Regulatory Compliance,Claims Analysis & Investigation,Fraud,Compliance
Additional Skills & Qualifications
• Must hold a bachelor's degree.
• Minimum of 5-7 years of experience in a healthcare program integrity role ensuring compliance with regulatory and contractual requirements.
• Expertise in healthcare fraud and abuse prevention, detection, and investigative processes, with the ability to design, implement, and oversee a fraud and abuse program.
• Knowledge of healthcare fraud, waste, and abuse (FWA) methodologies, investigative approaches, and applicable regulations.
• Healthcare industry and/or Medicaid/CHIP knowledge.
• Must be able to travel, as business needs require, for quarterly Medicaid Program Integrity (MPI) meetings and other organizational meetings. Travel is typically one (1) to three (3) consecutive days per occurrence.
• Must hold a nationally recognized anti-fraud certification, such as Accredited Health Care Fraud Investigator (AHFI) and/or Certified Fraud Examiner (CFE)oOr the ability to achieve a nationally recognized anti-fraud certification within 1 year/12 months of employment
Experience Level
Expert Level
Job Type & Location
This is a Contract to Hire position based out of Sunrise, FL.
Pay and Benefits
The pay range for this position is $43.27 - $48.07/hr.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)
Workplace Type
This is a hybrid position in Sunrise,FL.
Application Deadline
This position is anticipated to close on Aug 10, 2026.
About Aston Carter
Aston Carter provides world-class corporate talent solutions to thousands of clients across the globe. Specialized in accounting, finance, human resources, talent acquisition, procurement, supply chain and select administrative professions, we extend the capabilities of industry-leading companies. We draw on our deep recruiting expertise and expansive network to meet the evolving needs of our clients and talent community with agility and excellence. With offices across the U.S., Canada, Asia Pacific and Europe, Aston Carter serves many of the Fortune 500. We are proud to be a ClearlyRated Best of Staffing® Platinum Award winner for both client and talent service.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email astoncarteraccommodation@astoncarter.com for other accommodation options.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.