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Program Integrity Director Jobs in Saint Augustine, FL

ARC Group

Medical Director

Jacksonville, FL · Remote

Program Integrity 20% * Support program integrity initiatives, including identifying trends in ... Medical Director experience in Medicare-related or commercial healthcare organization * Coding and ...

usahs

Director, Curriculum and Assessment

Austin, TX · On-site

... Programs. The Director ensures the integrity, alignment, and continuous improvement of the curriculum by overseeing its development, implementation consistency, and evaluation across multiple ...

RogueSearch

Director of Safety

Jacksonville, FL · On-site

Manages corporate insurance programs including general and auto liability, property, and worker ... Possess good judgment, problem-solving and decision-making skills, and integrity * Strong ...

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All JobsProgram Integrity JobsProgram Integrity Director JobsProgram Integrity Director Jobs in Saint Augustine, FL

Program Integrity Director information

See Saint Augustine, FL salary details

$25.7K

$68.2K

$119.5K

How much do program integrity director jobs pay per year?

As of Sep 5, 2026, the average yearly pay for program integrity director in Saint Augustine, FL is $68,207.00, according to ZipRecruiter salary data. Most workers in this role earn between $46,200.00 and $80,700.00 per year, depending on experience, location, and employer.

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 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 job categories do people searching Program Integrity Director jobs in Saint Augustine, FL look for?

The top searched job categories for Program Integrity Director jobs in Saint Augustine, FL are:

What cities near Saint Augustine, FL are hiring for Program Integrity Director jobs?

Cities near Saint Augustine, FL with the most Program Integrity Director job openings:

Program Integrity Director jobs near you

Medical Director

ARC Group

Jacksonville, FL • Remote

Full-time

Re-posted 3 days ago

Key responsibilities

  • Provide leadership in clinical program outreach, provider education, and development of clinical guidelines.

  • Collaborate with CMS and other stakeholders to develop and update medical policies and ensure compliance with Medicare regulations.

  • Oversee medical review activities, including claim determinations, appeals, and development of quality assurance programs.

Job description

MEDICAL DIRECTOR - REMOTE
ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people.
At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply.
100% REMOTE!
Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering).
SUMMARY STATEMENT
The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare.
ESSENTIAL DUTIES & RESPONSIBILITIES
Clinical Expertise and Consultation 30%
  • Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community.
  • Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed.
  • Keep clinical knowledge up to date and abreast of medical practice and technology changes.
  • Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program.
  • Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders.
  • Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas.
Collaboration and Leadership 30%
  • Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements.
  • Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives.
  • Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues.
  • Represent the MAC at CMS meetings and industry conferences.
  • Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews.
Program Integrity 20%
  • Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance.
  • Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines.
  • Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making.
  • Collaborate with investigative teams and law enforcement when required.
Medical Review (MR) and Appeals 10%
  • Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations.
  • Provide leadership in developing and implementing MR Quality Assurance Programs.
  • Provide leadership in effectively focusing MR and developing internal MR guidelines.
  • Review complex or high-level appeals and provide guidance on the application of Medicare policies.
  • Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings.
Provider Education and Communication 10%
  • Provide leadership in the provider community (including interacting with hospital/specialty associations).
  • Educate providers, individually or as a group, regarding identified problems or medical policy.
  • Maintain Professional and Organization Relationships
    Performs other duties as the supervisor may, from time to time, deem necessary.
  • Travel within and outside the assignedjurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs.
REQUIRED QUALIFICATIONS
  • MD or DO degree from accredited Medical School
  • Minimum of three years clinical practice experience as an attending physician
  • Extensive knowledge of the Medicare program, particularly the coverage and payment rules
  • Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
  • Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure
  • Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population
  • Basic understanding of medical coding conventions
  • Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities
  • Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services
  • Proficiency with effective public speaking and ability educate providers
  • Ability to work collaboratively with clinical and non-clinical team members
  • Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.)
  • Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications
  • Ability to complete independent or computer-based training and education
    Certifications, Licenses, Registration:
  • Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States
  • Eligible for licensure within jurisdiction of enterpriseoperations
  • Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years
PREFERRED QUALIFICATIONS
  • Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice
  • MBA, MHA, MS in Management, or formal accredited coursework in medical systems management
  • Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership
  • Medical Director experience in Medicare-related or commercial healthcare organization
  • Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes
  • Experience using GRADE methodology for literature analysis and performing systematic reviews
  • Experience working with physician groups, beneficiary organizations, and/or congressional offices

Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke at johnb@arcgonline.com or apply online while viewing all of our open positions at www.arcgonline.com.
ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed.
At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know.
Position is offered with no fee to candidate.