Compliance Officer

What You Will Do

• Essential Functions

We are seeking a strong, hands‑on Compliance leader to oversee and build a comprehensive corporate, regulatory, and privacy compliance programs across our behavioral health and in‑home primary care service lines. This role ensures enterprise‑wide compliance with federal and state laws, accreditation standards, payer requirements, and contractual obligations, while working closely with internal teams and external partners to support a culture of ethical, compliant operations.

• Compliance & Privacy Program Oversight
• Lead and maintain organization‑wide compliance and privacy programs aligned with CMS, NCQA, URAC, HIPAA, HITECH, and federal/state regulations.
• Conduct risk assessments and develop compliance plans, controls, and KPIs to ensure regulatory adherence.
• Risk, Audit & Program Integrity Management
• Manage internal audits, regulatory audits, accreditations, and controls to prevent and detect unethical or improper conduct.
• Oversee Program Integrity investigations to identify, investigate, remediate, and refer cases of fraud, waste, and abuse.
• Cross‑Functional Collaboration & Compliance Culture
• Partner with internal and external stakeholders, including leadership and the Board, to ensure compliance across products, processes, and initiatives.
• Build a strong culture of compliance through training, education, and support that makes compliance easy and embedded in daily operations.

Required Qualifications

• Bachelor’s degree
• Advanced degree preferred (JD, MBA, MPH, MHA, or equivalent)
• 10+ years of progressive leadership experience in compliance, regulatory affairs or risk management within a health care services, delivery or technology organization.
• 5+ years of executive-level leadership in compliance, internal audit, or related oversight functions.
• 5+ years of managed care experience with a health plan working through Medicare and health insurance regulatory requirements.
• 3 years of program integrity, claim integrity or SIU experience relating to fraud, waste, and abuse.
• Demonstrated leadership, including proven ability to establish a vision and drive structural change across the organization.
• This position requires driving. Employee must have an active driver’s license and must be insurable.
• Ability to translate regulatory and legal requirements into practical, actionable advice and programs.
• Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen.