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Program Integrity Jobs in Virginia (NOW HIRING)

KidsPeace

FOSTER CARE PROGRAM MANAGER

Richmond, VA · On-site

$26.24/hr

Maintain program integrity by conducting the Quality Assessment and Improvement processes within the office. Ensure compliance in all areas as required by KidsPeace, State licensing and program ...

KidsPeace

FOSTER CARE PROGRAM MANAGER

Richmond, VA · On-site

$26.24/hr

Maintain program integrity by conducting the Quality Assessment and Improvement processes within the office. Ensure compliance in all areas as required by KidsPeace, State licensing and program ...

InterSystems

Subject Matter Expert

Vienna, VA · On-site

InterSystems' mission is to help agencies reduce improper payments, improve program integrity, and increase trust in public healthcare systems. We believe we can do this by enabling measurable impact ...

InterSystems

Subject Matter Expert

Vienna, VA · On-site

InterSystems' mission is to help agencies reduce improper payments, improve program integrity, and increase trust in public healthcare systems. We believe we can do this by enabling measurable impact ...

Akima, LLC

Program Manager

Fort Belvoir, VA · On-site

$150K - $250K/yr

Implements quality assurance processes and change management strategies to maintain program integrity. * Provides financial oversight, including budget planning, cost analysis, and forecasting.

Commence

Program Manager - SSA

Leesburg, VA · On-site

$140K - $160K/yr

Drive program integrity through rigorous quality assurance processes, ensuring all deliverables meet federal compliance standards and non-adjudicative boundaries where applicable * Manage ...

Peraton

Administrative Action Lead

Reston, VA · On-site

At least 5 years of experience in Medicaid or Medicare program integrity, investigations, audits, administrative actions, or healthcare compliance. * Experience working directly with state Medicaid ...

Peraton

Administrative Action Lead

Herndon, VA · On-site

At least 5 years of experience in Medicaid or Medicare program integrity, investigations, audits, administrative actions, or healthcare compliance. * Experience working directly with state Medicaid ...

Warren County Department of Social Services

Be Seen First

Benefit Programs Supervisor

Front Royal, VA · On-site

$59K - $89K/yr

The supervisor plays a key role in program integrity, staff development, workflow management, and community service coordination. Key Responsibilities Program Leadership & Oversight • Supervise ...

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Warren County Department of Social Services

Be Seen First

Benefit Programs Supervisor

Front Royal, VA · On-site

$59K - $89K/yr

The supervisor plays a key role in program integrity, staff development, workflow management, and community service coordination. Key Responsibilities Program Leadership & Oversight • Supervise ...

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All JobsProgram Integrity JobsProgram Integrity Jobs in Virginia

Program Integrity information

See Virginia salary details

$24.8K

$51.9K

$89.7K

How much do program integrity jobs pay per year?

As of Jul 8, 2026, the average yearly pay for program integrity in Virginia is $51,911.00, according to ZipRecruiter salary data. Most workers in this role earn between $39,700.00 and $59,000.00 per year, depending on experience, location, and employer.

What are some common challenges faced in a Program Integrity role, and how can they be effectively managed?

Program Integrity professionals often encounter challenges such as ensuring regulatory compliance, detecting and preventing fraud, and navigating complex data systems. Managing these challenges typically involves staying current with evolving policies, collaborating closely with compliance, audit, and legal teams, and leveraging advanced analytics tools to monitor program performance. Effective communication and proactive problem-solving are crucial, as the role often requires balancing the organization's objectives with strict adherence to external regulations.

What is the difference between Program Integrity vs Claims Analyst?

AspectProgram IntegrityClaims Analyst
Required CredentialsTypically requires a bachelor’s degree in healthcare, public health, or related fields; certifications like Certified Professional Coder (CPC) may be beneficialUsually requires a bachelor’s degree in finance, healthcare administration, or related fields; certifications like Certified Claims Professional (CCP) are common
Work EnvironmentGovernment agencies, insurance companies, healthcare organizations focusing on compliance and fraud detectionInsurance companies, healthcare providers, or third-party administrators analyzing claims data
Employer & Industry UsagePrimarily in healthcare, insurance, and government sectors for compliance and fraud preventionIn insurance and healthcare sectors for processing and analyzing claims

Program Integrity professionals focus on preventing fraud, waste, and abuse in healthcare programs, ensuring compliance with regulations. Claims Analysts primarily review and process insurance claims, verifying accuracy and eligibility. While both roles work within healthcare and insurance industries, Program Integrity emphasizes compliance and fraud detection, whereas Claims Analysts concentrate on claims processing and data analysis.

What are program integrity jobs?

Program integrity jobs focus on ensuring that government or organizational programs operate effectively, efficiently, and in compliance with laws and regulations. Professionals in these roles are responsible for identifying and preventing fraud, waste, and abuse, often through audits, investigations, and data analysis. They ensure program funds are used as intended, maintain accountability, and help organizations meet regulatory and ethical standards. These positions are commonly found in healthcare, social services, and government agencies.

What are the key skills and qualifications needed to thrive in a Program Integrity role, and why are they important?

To thrive in a Program Integrity role, you need strong analytical skills, attention to detail, and a solid understanding of compliance or regulatory frameworks, usually backed by a relevant degree such as public administration, law, or accounting. Familiarity with data analysis tools, case management systems, and auditing software is often required, along with certifications like Certified Fraud Examiner (CFE) being advantageous. Excellent problem-solving, ethical judgment, and effective communication are vital soft skills for investigating issues and collaborating with stakeholders. These competencies help ensure organizational compliance, prevent fraud, and safeguard resources in regulated environments.
Program Integrity jobs near you

Program Integrity & Investigations Specialist

Choice. Respect. independence. (CRi)

Chantilly, VA • On-site

Full-time

Re-posted 11 days ago

Job description

CRi is seeking a Program Integrity & Investigations Specialistto join our team!

Position Summary:

The Program Integrity and Investigations Specialist at CRi is responsible for monitoring program compliance in alignment with federal and state behavioral health provider regulations and industry standards. This role involves conducting thorough investigations into violations of Human Rights to ensure the protection and dignity of individuals served. Additionally, the Specialist performs comprehensive audits across all service programs, identifying areas for improvement and strengthening organizational oversight.

By driving adherence to regulatory requirements and best practices, this position plays a critical role in enhancing service quality, promoting accountability, and supporting continuous improvement within the organization.

Principal Duties and Responsibilities:

Program Compliance Monitoring: Reviews program files (medical, financial, service planning) and conducts environmental inspections to ensure compliance with regulations and the Clinical Policy and Procedure Manual.

Audit and Review: Conducts audits, identifies areas for improvement, and supports corrective action plan development and implementation.

Investigations: Leads internal investigations into compliance issues (e.g., abuse, neglect) and prepares accurate reports.

Quality Improvement and Compliance (QIC) Oversight: Supports internal QIC reviews, prepares quarterly reports, and helps monitor and improve service delivery processes.

Recommendations and Systemic Improvements: Prepares recommendations for program and systemic improvements and evaluates the impact of changes on compliance and performance.

Regulatory Inspections and Reporting: Participates in inspections, contributes to compliance reports, and prepares monthly, quarterly, and annual QIC activity reports.

ICF Manual Maintenance: Maintains and updates the agency's ICF manual to ensure it reflects current regulatory standards.

Operational Support: Assists with audits and creates tools, templates, and guidance documents to improve operational efficiency.

Additional Duties: Performs other duties as needed to support departmental and organizational goals.

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