Leadership - Director of Program Integrity at Pacer Group

Job Title : Perm - Leadership - Director of Program Integrity

Location: Dallas, TX (Onsite at least 6 days/month)

Start Date: 11/3/2025

Duration: Permanent

Schedule Shift: Days, Monday–Friday, 8:00 AM – 5:00 PM

Pay Rate: $61.06 – $96.15 (DOE)

Description:

TITLE: Perm - Leadership - Director of Program Integrity

Position Overview:

The Director of Program Integrity leads initiatives focused on claims editing, fraud/waste/abuse (FWA) prevention, and payment accuracy. You’ll drive operational excellence, cost containment, and compliance with state and federal requirements while fostering a culture of integrity across the organization.

EDUCATION/EXPERIENCE/TRAINING

Required:

• 5+ years management experience – Required
• 8+ years Payment Integrity Audit & Recovery experience (data mining, clinical review, audit recovery) – Strongly Preferred
• 2+ years Managed Care health plan or state agency experience – Required
• Strong knowledge of ICD-10, CPT/HCPC coding, and Texas Medicaid programs (STAR, STAR Kids, CHIP)
• Project Management or Six Sigma Certification – Strongly Preferred
• Bachelor’s degree or equivalent experience (8+ years in comparable Medicaid position may substitute)

DUTIES AND RESPONSIBILITIES

• Lead and optimize the Program Integrity department and related functions.
• Identify and implement process improvements to boost efficiency and effectiveness.
• Develop annual goals, objectives, and budgets aligned with organizational mission.
• Maintain compliance with Texas Medicaid, NCQA, and managed care regulations.
• Supervise, mentor, and evaluate team members for optimal performance.
• Stay current with industry trends and integrate best practices into operations.