Program Integrity Director

* Position is Eligible for Remote / Work from Home Opportunity*
Department: Executive Operations
Telecommuting Eligible: Yes
Job Grade: E16
As a condition of employment, physical work location must be in one of the 50 states or the District of Columbia.
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Job Title
Program Integrity Director
Job Summary

The Program Integrity Lead defines and leads Noridian 's enterprise Program Integrity strategy, with a primary focus on Medicare programs and initiatives that advance fraud, waste, and abuse prevention, payment integrity, medical review, provider audits, data analytics, and compliance operations. Serving as Noridian 's strategic authority in Program Integrity, this leader identifies opportunities to strengthen Medicare contracts, expand service capabilities, drive innovation for Centers for Medicare & Medicaid Services (CMS) and other federal customers, and improve operational performance. The role is accountable for developing and executing a multi-year strategy that enhances contract value, supports revenue growth, advances CMS objectives, and positions Noridian as an industry leader in Program Integrity.
Essential Functions
(Key Duties/Responsibilities/Accountabilities)
Organizational Impact:

• Develops and maintains Noridian 's enterprise Program Integrity strategy and roadmap.

• Establishes a future-state vision for Program Integrity capabilities across Medicare operations.

• Creates executive recommendations regarding investments, technology, partnerships, staffing models, and operational enhancements.

• Develops and executes a growth strategy focused on expanding Program Integrity work within Noridian 's existing Medicare and Medicaid contracts as well as new bid opportunities..

• Identifies opportunities to increase contract value through additional CMS scope, new demonstrations and pilots, Program Integrity authorities, provider audit services, advanced analytics capabilities, automation and 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 financial impact, quality outcomes, operational performance, customer satisfaction, compliance effectiveness, and program return on investment.

• Ensures alignment between Program Integrity initiatives, quality strategy, compliance requirements, and enterprise objectives.
Communications & Influence:

• Partners with Business Development, Government Affairs, Customer Relations, and Operations leaders to position Noridian as a trusted CMS advisor.

• Supports customer engagement efforts by preparing thought leadership materials, CMS presentations, concept papers, and value propositions.

• Builds relationships with CMS leaders, Medicare stakeholders, industry partners, vendors, and professional organizations.

• Represents Noridian in industry forums, conferences, customer discussions, and strategic planning sessions.

• Advises senior leadership regarding investment decisions, emerging technologies, and future Program Integrity opportunities.

• Fosters collaboration between operational, technical, clinical, compliance, and business development teams.
Innovation & Complexity:

• Identifies emerging CMS priorities, regulatory trends, fraud schemes, payment integrity initiatives, and policy changes that may create risks or opportunities.

• Evaluates and recommends opportunities involving medical review, provider audits, data analytics, prior authorization, fraud prevention, predictive analytics, payment integrity, and AI-enabled Program Integrity solutions.

• Evaluates external partnership opportunities that strengthen Noridian 's Program Integrity capabilities and competitive position.

• Defines i