Program Integrity Manager

Position Summary: The Program Integrity Manager serves as the credential verification subject matter expert for the FPOCF System of Care Provider Network. This position is responsible for screening prospective providers before contract or rate agreement execution, verifying provider credentials and legitimacy, and conducting ongoing monitoring of existing providers. This includes cross-walking provider staff qualifications and third-party provider qualifications against the menu of clinical, behavioral health, mental health, and substance abuse treatment services to verify required credentials, relevant degree or education, licensure, and specialty certifications needed to deliver high-quality services to children and families. The Program Integrity Manager conducts ongoing audits, collaborates with the Contracts and Compliance department, reports to the Senior Director of Provider and Stakeholder Partnerships, and participates in the third tier on-call rotation.

Technical Functions include:

1.       Credentialing Verification Subject Matter Expert- Verifies and monitors provider credentials, relevant degrees or education, specialty certifications, and legitimacy of service providers in the FPOCF System of Care Provider Network.

2.       Screening of New Providers/Ongoing Monitoring and Audits of Existing Providers- Engages in proactive provider screening  of new providers to ensure the required credentials, licensure and training to effectively deliver specific contacted service. Continuous review of professional’s credentials, background, and qualification of current contracted providers. Tracks real-time changes to prevent safety risks.

3.       Florida State Medicaid Managed Care Provider Search- Utilizes Florida State Medicaid Managed Care Provider Search to check providers and specialists participating in state programs.

4.       Licensing Verification-Utilizes the Florida Department of Health Medical Quality Assurance Search for license verification and practitioner profile.

5.       Interface with the Managing Entity- Collaborates with non-profit corporation contracted by the state to oversee local mental health and substance abuse services to check provider status and review provider performance.

6.       Agency Representative Provider Concerns-Lead on any reported concerns in activity or intentional deception or misrepresentation from clinical, behavioral and substance abuse providers.

7.       Programmatic Compliance-Ensures compliance with all regulatory, accreditation, and contractual requirements, adheres to all applicable regulatory, accreditation, and professional ethics standard.

8.       Other duties as required: Job performance requires fulfilling other incidental or related duties as assigned, assisting, and training others, and performing duties of higher rated positions from time to time for developmental purposes.

Behavioral Competencies:

1.       Influence: Able to positively change opinions and actions of others in a desired direction; present information in a persuasive manner; clarify information to gain understanding and buy-in.

2.       Develop Relationships: Able to relate with others while building credibility and rapport; give personal support and reassurance; put others at ease; build cooperative relationships.

3.       Responsiveness: Able to take action to meet the needs of others; respond to solving problems; minimize delays or problems with little or no supervision.

4.       Trust and Respect: Able to demonstrate respect and treat others in an honest and straightforward manner; keep dealing with others confidential; and follow through on commitments.

5.       Customer Service: Able to anticipate and respond to customers’ needs, concerns, or questions to meet or exceed their expectations; help evaluate needs and options; show care and concern to demonstrate customer importance and value.

6.       Innovation: Able to generate new or different processes, or solutions; create unique solutions to problems.

express fresh insights or innovations regularly; think outside of existing paradigms.

7.       Sensitivity: Work effectively with and show sensitivity to cultural differences and various socio-economic backgrounds of others.

8.       Ethics: Adhere to and model principles and values of Agency and System of Care by being strength-based,

solution-focused, maintains the highest level of integrity and ethical standards and collaborates with employees, partners, stakeholders, and clients in all interactions.

Business Experience:

1.       Valid Driver’s License- Required to travel throughout the county and other locations for family and other meetings.

2.       Strong Organizational, Oral and Written Communication Skills: This position requires strong organizational and time management skills as well as the ability to compose and present management reports in a succinct yet thorough, informative, and efficient manner. Strong oral and written communication skills are essential.

Educational and Experience Requirements:

1.           MA/MS – master’s degree or equivalent in behavioral health field (i.e., social work, counseling) required.

2.           Knowledge of Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling on therapist qualifications and licensing rules required.

3.           10 years’ Clinical experience preferred.

4.           Florida Licensed Mental Health Counselor or Licensed Clinical Social Worker required.       

Physical Requirements:

1.       Lifting 20 pounds

2.       Carrying 20 pounds

3.       Grasping

4.       Reaching

5.       Sitting

6.       Standing

7.       Stooping / Crouching

8.       Bending

9.       Near Acuity

10.     Reading

11.     Speaking

12.     Listening

13.     Typing

14.     Writing

For more information regarding our screening process please visit Clearinghouse.com .

Family Partnerships of Central Florida is an Equal Opportunity/Affirmative Action employers All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status. These employers also maintain Drug-Free Workplaces. Requests for Auxiliary Aids for Hearing Impaired or Limited English Proficiency Candidates may be made with a minimum of five (5) days notice to C. Hernandez at (321) 752-4650.