Perm - Leadership - Director of Program Integrity (Days) Dallas TX

"Care, Compassion, Community."

"As one of the largest public hospital systems in the country, Parkland Health & Hospital System is dedicated to providing valuable health and well-being services to those entrusted to our care."

Hourly Range : Min $61.06 Mid $82.45 Max $103.85

25% Perm Placement Fee

The Director of Program Integrity provides leadership oversight and directs the operations for the Program Integrity department and

associated functions with focus on claims editing, fraud, waste, and abuse (FWA) prevention, and

payment accuracy. Accountable for supporting Parkland Community Health Plan s (PCHP) commitment

to operational excellence, cost containment, and adherence to state and federal requirements.

Job Responsibilities :

1. Identifies and analyzes the design of jobs, work processes, work flows, etc. for the area and

implements appropriate changes to improve effectiveness, productivity, and efficiency that

support the overall goals of PCHP.

2. Stays abreast of the latest developments, advancements, and trends in the field by attending

seminars / workshops, reading professional journals, actively participating in professional

organizations, and / or maintaining certification or licensure. Integrates knowledge gained into

current work practices.

3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the

area. Develops effective internal controls designed to promote adherence with applicable laws,

accreditation agency requirements, and customer requirements. Seeks advice and guidance as

needed to ensure proper understanding.

4. Develops and monitors annual budgets that ensure the department has the necessary funds to

carry out the goals and objectives that have been established for the department.

5. Develops, implements, monitors, and revises annual goals and objectives for the department that

support the missions and objectives of PCHP.

6. Selects, trains, schedules, motivates, supervises, and evaluates employees making

recommendations for disciplinary actions up to and including termination, to ensure maximum

utilization of individual and group capabilities. Ensures that assigned employees receive

opportunities to further their knowledge.

Skills or Special Abilities :

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms.
• Demonstrated ability to coach and influence for results.
• Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization.
• Strategic thinking and long-range planning skills with the ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals.
• Ability to work in challenging situations involving competing interests, and high level interdisciplinary groups.
• Excellent time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Strong analytical and problem-solving skills.
• Knowledge of Texas Medicaid (STAR, STAR Kids / CHIP) program, National Committee for Quality
• Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
• Sound business acumen.
• Proficient Microsoft Office and computer skills.
Benefits :
• Medical
• Dental
• Vision
• Life Insurance
• Disability Insurance
• Flexible Spending Accounts
• And more!

Requirement description :

"By submitting your applicant to this need you are acknowledging that you have checked and have no inclination that your candidate has applied directly to this position. Any candidate that has applied directly is not eligible to be onboarded through an agency."

Experience :

Certification / Registration / Licensure

ADDITIONAL LICENSE REQUIREMENTS :

Weekend Requirements :

On Call Requirements :