Medicare Program Integrity Leader

Noridian Healthcare Solutions; Fargo (ND); On-site; USD 105,000 - 172,000; Full time

Benefits offered by this job

Health, Dental and Vision Insurance

401k and Company Match

Paid Leave & Holidays

Education Assistance Program

Flexible Spending Accounts

Job summary

Noridian Healthcare Solutions in Fargo, ND seeks a Program Integrity Director to define and lead the enterprise Program Integrity strategy focused on Medicare programs, fraud prevention, data analytics, and compliance operations. You will drive multi-year plans, negotiate investments, and align initiatives with CMS objectives and enterprise goals.

The role requires strong leadership, stakeholder management, and the ability to translate strategy into actionable programs across Noridian's Medicare

Qualifications

• Bachelor's degree or equivalent work experience in a relevant field.
• 10 years of progressive healthcare, Medicare, Medicaid, federal health programs, audit, compliance, or Program Integrity experience, including 7 years in leadership roles.
• Experience developing enterprise strategies and translating them into operational execution plans.
• Strong knowledge of Medicare operations, CMS programs, and federal healthcare contracting.
• Experience presenting to senior executives and external stakeholders.
• Exceptional communication, relationship management, and strategic planning skills.

Responsibilities

• Develops and maintains Noridian's enterprise Program Integrity strategy and roadmap.
• Establishes a future-state vision for Program Integrity across Medicare operations.
• Creates executive recommendations regarding investments, technology, staffing, and operational enhancements.
• Develops and executes growth strategy to expand Program Integrity work within Medicare/Medicaid contracts and new bid opportunities.
• Identifies opportunities to increase contract value through CMS scope, pilots, analytics, AI solutions, and medical review modernization.
• Builds business cases supporting additional Medicare work and contract modifications.
• Translates approved strategies into executable operational plans.
• Establishes performance metrics and dashboards to monitor impact and ROI.
• Ensures alignment with quality, compliance, and enterprise objectives.

Skills

Leadership

Strategic Planning

Communication

Problem Solving

Analytical

Education

Bachelor's degree in Business, Healthcare Administration, Public Administration, Data Analytics, Nursing, Health Information Management, or related field OR equivalent work experience.

Master's degree (MBA, MHA, MPH, or related field) preferred

Job description

Noridian Healthcare Solutions in Fargo, ND seeks a Program Integrity Director to define and lead the enterprise Program Integrity strategy focused on Medicare programs, fraud prevention, data analytics, and compliance operations. You will drive multi-year plans, negotiate investments, and align initiatives with CMS objectives and enterprise goals.

The role requires strong leadership, stakeholder management, and the ability to translate strategy into actionable programs across Noridian's Medicare