Director of Compliance Operations & Optimization

Reporting directly to the Chief Compliance and Privacy Officer, this role ensures the organization meets federal, state, accreditation, and other regulatory requirements. The Director serves as a trusted advisor to the Chief Compliance and Privacy Officer and various committees and councils, providing day-to-day oversight of and direction to the Regional Compliance and Privacy Managers. The Director partners with leaders across clinical, operational, and administrative areas to promote a culture of integrity, regulatory readiness, and continuous improvement.

Responsibilities

• Ensures communication channels operate effectively to support the timely remediation of compliance concerns raised through internal reports, the hotline, and exit interviews.
• Conducts targeted research across statutes, rules, and guidance documents to develop compliant, evidence-based advice.
• Monitors, analyzes, and interprets regulatory requirements and industry guidance to assess organizational risk and evaluate the impact on business operations and compliance obligations.
• Directs the Facility Compliance Liaison Program by expanding participation to strengthen local compliance ownership.
• Manages go-live readiness and ongoing compliance related to provider-based entities, identifying areas of vulnerability and collaborating with operational leaders to implement corrective action plans.
• Leads the implementation, administration, and ongoing optimization of the compliance performance management system and enterprise compliance case management repository, ensuring data integrity, reporting accuracy, and effective system utilization.
• Ensures written compliance standards — including policies, procedures, the Code of Conduct, the Compliance Plan, and Annual Report — remain current, accurate, and aligned with evolving regulatory requirements and program guidance.
• Owns the design, development, and governance of the compliance education program, including new-hire orientation, annual mandatory training modules, and leadership-focused communications, ensuring materials reflect current regulatory requirements, organizational policies, and risk priorities.
• Assures compliance with Medicare Advantage First Tier, Downstream, and Related Entity (FDR) requirements by monitoring delegated entities, facilitating audits, maintaining documentation, and implementing corrective action plans to meet CMS standards.
• Facilitates non-billing external audits, investigations, and self-reporting obligations by coordinating with regulatory agencies, preparing audit materials, overseeing evidence collection, managing cross-functional responses, and ensuring findings are addressed through corrective action plans.
• Represents the compliance department on various organizational councils, committees, and workgroups to ensure compliance considerations are integrated into decision-making, policy development, and operational planning.

Requirements

• A bachelor’s degree in a healthcare compliance-related field such as legal studies, health information management, nursing, public policy, or risk management, and at least 10 years of relevant experience.
• Or a master’s degree in a healthcare compliance-related field such as MBA, MPA, MHA, JD, MSN, or MPH, plus 7 years of relevant experience.
• Experience and/or ability to interpret and operationalize regulatory requirements related to areas such as:
  • Provider-Based Regulations
  • Stark and Anti-kickback Statutes
  • CMS Conditions of Participation
  • Accreditation Survey Standards
  • EMTALA Obligations
  • Conflicts of Interest
  • Affordable Care Act
  • Lewis Blackman Act
  • CMS First-Tier Downstream and Related Entity Obligations
  • 340B Drug Pricing Program Provisions
  • Cost Reporting Compliance
  • Durable Medical Equipment Requirements
  • Research Compliance
  • Home Infusion Standards
  • Medicare Secondary Payor Requirements
  • CMS Quality Reporting Programs
  • Telehealth Regulations
  • Direct and Indirect Graduate Medical Education (GME) requirements
  • Fraud, Waste, and Abuse Obligations
• Strong leadership, consultative, and analytical skills.
• Exceptional interpersonal and communication skills, with the ability to work independently with minimal supervision.
• Ability to work well in a fast-paced, growing environment that requires adaptability, collaboration, and proactive problem-solving.
• Proficiency in modern technology platforms and emerging AI capabilities, with the ability to evaluate, adopt, and apply digital tools to improve efficiency, analytics, and program effectiveness.
• Certification such as CHC, CRMA, CCEP, or equivalent preferred.

Physical Requirements

• Ability to perform job functions while standing (Frequent).
• Ability to perform job functions while sitting (Frequent).
• Ability to perform job functions while walking (Frequent).
• Ability to climb stairs (Infrequent).
• Ability to work indoors (Continuous).
• Ability to work from elevated areas (Frequent).
• Ability to work in confined/cramped spaces (Infrequent).
• Ability to perform job functions from kneeling positions (Infrequent).
• Ability to bend at the waist (Frequent).
• Ability to squat and perform job functions (Infrequent).
• Ability to perform repetitive motions with hands/wrists/elbows and shoulders (Frequent).
• Ability to reach in all directions (Frequent).
• Good finger dexterity (Continuous).
• Ability to fully use both legs (Continuous).
• Ability to fully use both hands/arms (Continuous).
• Ability to lift and carry 15 lbs. unassisted (Infrequent).
• Ability to lift/lower objects 15 lbs. from/to floor from/to 36 inches unassisted (Infrequent).
• Ability to lift from 36 inches to overhead 15 lbs. (Infrequent).
• Ability to maintain 20/40 vision, corrected, in one eye or with both eyes (Continuous).
• Ability to see and recognize objects close at hand or at a distance (Continuous).
• Ability to match or discriminate between colors (Continuous).
• Ability to determine distance/relationship between objects; depth perception (Continuous for selected positions).
• Ability to maintain hearing acuity, with correction (Continuous).
• Ability to perform gross motor functions with frequent fine motor movements (Continuous).
• Ability to work in a latex-safe environment (Continuous).
• Ability to maintain tactile sensory functions (Frequent).
• Ability to maintain good olfactory sensory function (Frequent for selected positions).

Pay

Pay Grade: Health-35

Schedule

Scheduled Weekly Hours: 40