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Director of Healthcare Compliance, Value-Based Care & Risk Adjustment

📅 Jul 10
Compliance Program ManagementHealthcare RegulationsRisk AssessmentInternal Investigations

📜 Description

  • Lead and strengthen the enterprise compliance program across corporate and clinical compliance.
  • Maintain policies, standards, procedures, evidence, reporting, and governance aligned with OIG guidance and applicable federal and state healthcare requirements.
  • Conduct compliance risk assessments and help build annual compliance work plans.
  • Monitor regulatory changes and translate them into practical operating requirements.
  • Lead internal compliance investigations, root-cause analysis, corrective action plans, and follow-through.
  • Partner with Clinical Operations, Legal, HR, Information Security, Revenue Cycle, Quality, Credentialing, and Executive Leadership.

🛠️ Requirements

  • Direct compliance experience in value-based care, population health, risk adjustment, Medicare Advantage, Medicaid, home-based care, or a comparable healthcare enablement environment.
  • 7+ years of progressively responsible healthcare compliance experience.
  • 3+ years in a compliance leadership role.
  • A progressive, explainable compliance career history with increasing scope, stable tenure, and current or recent work in a relevant healthcare environment.
  • Experience managing both corporate and clinical compliance programs.
  • Experience leading internal investigations, audits, regulatory inquiries, and corrective action plans.
  • Ability to translate complex regulatory requirements into practical operating processes.
  • Strong executive communication, judgment, documentation, and cross-functional leadership.
  • Comfort operating in a growing, multi-state healthcare organization where compliance needs to be both rigorous and practical.
  • Experience with organizations similar to value-based care enablement, home assessment, population health, or risk adjustment platforms.
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