Pennsylvania Licensed Program Integrity Director

Job Summary

A company is looking for a Senior Director of Program Integrity and Special Investigations Unit.

Key Responsibilities

• Provide leadership and strategic direction for Special Investigations and Program Integrity units
• Ensure compliance with anti-fraud and program integrity regulations and present findings to executive leadership
• Manage vendor relationships, oversee audits, and develop a multi-year Program Integrity strategy aligned with financial goals

Required Qualifications

• Master's Degree required; Master's Degree in Law preferred
• Minimum of 10 years of experience in Health Insurance/Managed Care
• Minimum of 5 years of managerial or supervisory experience
• Experience in managing budgets and financial performance
• Proven track record in leading teams and overseeing compliance activities