Integrity & Compliance Program Manager

Role Overview

• Accountable for leading, guiding, and directing the Trinity Health ministry or enterprise functional responsibilities.
• Enable ministry-level or enterprise-wide functional strategy to address internal or external business & regulatory issues; provide functional expertise and ensure fulfillment of performance and service standards.
• Responsible for consistent operating performance and achieving financial goals.
• Identifies, defines & solves complex problems that impact the management & direction of the business; Collaborates with System Services Areas, Regions, and Health Ministries to ensure consistency and integration of strategy and operations.
• Maintaining awareness of new industry developments and standards.
• Provides decision support, operations &/or optimization leadership focus.
• Assist the Integrity and Compliance Director with guiding and managing the compliance activities and initiatives for assigned ministry(ies).
• Provides advice, guidance and program management to ministry leaders in developing, implementing and attaining program goals while ensuring alignment to compliance strategies.
• Conducts investigations for local ministry and provides recommended action in response to outcome of investigation.
• Participates in Service Area and Enterprise Integrity and Compliance projects with a focus on standardization and process improvements.
• Support the Integrity and Compliance Director in developing, executing, and overseeing compliance initiatives within the ministry.
• Provide expert advice and strategic guidance to ministry leaders on program goals and compliance strategies.
• Lead and conduct internal investigations related to compliance concerns, ensuring thorough, timely, and objective outcomes.
• Deliver well-documented recommendations for corrective actions based on investigative findings.
• Partner with leaders across local ministries and enterprise functions to implement and sustain compliance strategies.
• Actively participate in Service Area and Enterprise-level compliance projects, focusing on process improvement and standardization.
• Collaborate on the development and rollout of organization-wide policies, training, and communication tools to foster a culture of ethics and compliance.
• Monitor emerging risk areas and regulatory changes, ensuring proactive and appropriate organizational response.
• Contribute to audit readiness activities and help strengthen internal controls across the ministry.
• Track compliance performance metrics and support continuous improvement initiatives to enhance overall program effectiveness.

Requirements

• Bachelor’s level degree in business, health administration, or a related field, a law degree, or an equivalent combination of education & experience.
• Minimum of five 5 years of relevant experience with increasing levels of responsibility in health care compliance &/or consulting including regulatory compliance, program metrics, performance assessment, & reporting outcomes, etc.
• Must possess a thorough understanding and knowledge of health care legal and regulatory practices, financial and internal control systems/procedures.
• Previous project, program, supervisory or management experience.
• Experience within a health care organization (including ambulatory and hospital settings) or equivalent work experience involving clinical documentation and coding reviews and working knowledge of Conditions of Payment including government and third
• party payer regulations.
• Must understand and have expertise with Patient Driven Payment Models, Patient Driven Groupings Models, IRF-PAI and OASIS requirements.
• Comprehensive understanding of Medicare Physician Fee Schedule and Medicare Claims Processing Manual for professional services.
• Comprehensive understanding of Conditions of Participation and Accreditation Standards.
• CHC, CHPC, CHRC, CCEP or equivalent certification.
• Lean/Six Sigma training and/or certification.

Benefits

• Exposure to conditions which may be considered unpleasant to sight, touch, sound & / or smell.
• Occasional Exposure to fumes, odors, dusts, mists & gases, biohazards / hazards (mechanical, electrical, burns, chemicals, radiation, sharp objects, etc.).
• Occasional Exposure to or subject to noise, infectious waste, diseases & conditions.
• Occasional Exposure to interruptions, shifting priorities & stressful situations.
• Frequent Ability to follow tasks through to completion, understand & relate to complex ideas / concepts, remember multiple tasks & regimens over long periods of time & work on concurrent tasks / projects.
• Frequent Ability to read small print, hear sounds & voice / speech patterns, give / receive instructions & other verbal communications (in-person & / or over the phone / computer / device / equipment assigned) with some background noise.
• Frequent Perform manual dexterity activities & / or grasping / handling.
• Continuous Ability to climb, kneel, crouch & / or operate foot controls.
• Occasional Use a computer / other technology.
• Frequent Sit with the ability to vary / adjust physical position or activity.
• Frequent Maintain a safe working environment & use available personal protective equipment (PPE).
• Continuous Comply with Trinity Health’s Code of Conduct, policies, procedures & guidelines.
• Continuous Ability to provide assistance in the event of an emergency.