Program Integrity Manager

Family Partnerships of Central Florida•Maitland, FL

3d•Onsite

About The Position

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.

Requirements

MA/MS – master’s degree or equivalent in behavioral health field (i.e., social work, counseling) required.
Knowledge of Florida Board of Clinical Social Work, Marriage & Family Therapy and Mental Health Counseling on therapist qualifications and licensing rules required.
Florida Licensed Mental Health Counselor or Licensed Clinical Social Worker required.
Valid Driver’s License- Required to travel throughout the county and other locations for family and other meetings.
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.

Nice To Haves

10 years’ Clinical experience preferred.

Responsibilities

Verifies and monitors provider credentials, relevant degrees or education, specialty certifications, and legitimacy of service providers in the FPOCF System of Care Provider Network.
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.
Utilizes Florida State Medicaid Managed Care Provider Search to check providers and specialists participating in state programs.
Utilizes the Florida Department of Health Medical Quality Assurance Search for license verification and practitioner profile.
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.
Lead on any reported concerns in activity or intentional deception or misrepresentation from clinical, behavioral and substance abuse providers.
Ensures compliance with all regulatory, accreditation, and contractual requirements, adheres to all applicable regulatory, accreditation, and professional ethics standard.
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.