Position Overview

 

🚨 Now Hiring: Director of Program Integrity 🚨

📍 Location: Dallas, TX💰 Pay Range: Min $61.06 | Mid $82.45 | Max $96.15/hour🕒 Schedule: Full-Time; Hybrid [6 days onsite per month]

 

Why Join PCHP?

At Parkland Community Health Plan (PCHP), we’re dedicated to ensuring access to high-quality, cost-effective healthcare for our members. Our mission is rooted in integrity, innovation, and collaboration—values that guide everything we do. Join a forward-thinking organization where your leadership directly impacts program compliance, operational excellence, and the overall effectiveness of Medicaid and Managed Care initiatives in Texas.

 

 

 

 

Your Role as Director of Program Integrity:

As the Director of Program Integrity, you will provide strategic direction and oversight for PCHP’s program integrity initiatives. This includes developing and implementing effective controls, improving operational processes, and ensuring compliance with all applicable laws and regulations. You’ll lead a talented team to uphold the highest standards of integrity, efficiency, and accountability within the organization.

 

 

Key Responsibilities:

🔹 Operational Excellence & Process Improvement

• Identify and analyze job design, work processes, and workflows to improve effectiveness, productivity, and efficiency that support PCHP’s goals.

• Stay informed on the latest developments and trends by attending seminars, reading professional journals, and maintaining certifications or licenses.

• Integrate new knowledge into current practices to drive continuous improvement.

🔹 Compliance & Program Oversight

• Maintain up-to-date knowledge of applicable rules, regulations, laws, and policies impacting the department.

• Develop and monitor effective internal controls to ensure compliance with laws, accreditation standards, and customer requirements.

• Seek expert guidance as needed to ensure full understanding and compliance.

🔹 Financial & Strategic Leadership

• Develop and monitor annual budgets to ensure sufficient resources for achieving departmental goals.

• Establish, implement, and revise departmental goals and objectives that align with PCHP’s mission.

🔹 People Management & Team Development

• Select, train, supervise, and evaluate staff while fostering motivation and professional growth.

• Recommend and implement corrective actions when necessary, ensuring optimal team performance.

• Provide opportunities for ongoing learning and career development.

🔹 Other Duties as Assigned

• Participate in organizational initiatives that support operational and program integrity excellence.

What You Need to Succeed:

✔ Key Competencies:

• Strong leadership, analytical, and communication skills

• Deep understanding of audit strategies, data analytics, and Medicaid regulations

• Commitment to continuous improvement and regulatory compliance

✔ Qualifications:

• Minimum 5 years of management experience

• 8 years of experience in Payment Integrity Audit and Recovery with expertise in strategies such as Data Mining, Clinical Medical Record Review, and Bill Audit Recovery (strongly preferred)

• 2 years of experience in a Managed Care Health Plan or state agency (required)

• Knowledge of ICD-10 and CPT/HCPC coding guidelines and terminology (required)

• 8 years of experience in Texas Medicaid or Medicaid Managed Care may substitute for a bachelor’s degree

• 5 years of experience in Texas Medicaid, Managed Care Health Plan, or a state agency

• Project Management or Six Sigma certification (preferred)

 

📢 Apply Today!

Take the next step in your leadership career with PCHP—where integrity meets innovation and your expertise makes a lasting impact on Texas healthcare.

Pay Range

USD $61.06 - USD $96.15 /Hr.