Compliance Officer

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Provide strategic leadership and oversight for the compliance program of the health plan, which includes governance, regulatory strategy, policy formulation, and cross-functional implementation.

• Ensure that regulatory deliverables across business and operational areas are executed accurately and in a timely manner.

• Lead the design, execution, and ongoing effectiveness of the market compliance program, ensuring alignment with enterprise standards and regulatory expectations.

• Supervise compliance with CMS Medicare requirements, including obligations related to SNP, and ensure the timely submission of all regulatory filings and deliverables.

• Act as the senior compliance leader and the primary contact for state interactions, compliance meetings, and market-level escalations.

• Work collaboratively with Corporate Enterprise Risk Management and market leaders to identify, assess, document, and mitigate compliance and business risks.

• Conduct internal compliance audits and monitoring activities, direct the planning of corrective actions, and hold business owners accountable for timely remediation and sustained compliance.

• Oversee delegated entities, vendors, and material subcontractors, including annual performance monitoring and follow-up on corrective actions.

• Chair or support market compliance committees and provide regular reports to market and enterprise leadership on risks, trends, and remediation activities.

• Lead, coach, and develop compliance team members while establishing clear priorities, accountabilities, and performance expectations.

• For the New Jersey plan specifically, additional responsibilities include maintaining and tracking contract documentation, Medicaid contract amendments, and various regulatory measures.

• Collaborate with Operational Departments to ensure that policies, procedures, and processes are created and modified to meet state regulatory standards.

• Offer guidance to various departments regarding regulatory and contract language.

• Build strategic relationships with agencies within the New Jersey Department of Human Services and other state regulatory policymakers overseeing Managed Care organizations, Medicare, and Medicaid initiatives.

• Identify, evaluate, and analyze the implications of state regulatory changes and advise management on their impact.

• Represent senior management at various state committees, meetings, industry forums, and other engagements pertinent to compliance and regulatory strategy.

• Maintain extensive knowledge of New Jersey Medicaid and relevant state regulatory requirements.

⛳️ Requirements

• A Bachelor's Degree in a related field or equivalent experience is required.

• A Master's Degree in a related field is preferred.

• Over 7 years of experience in compliance program management and contract experience with State Medicaid programs, including internal and state audits, is required.

• At least 5 years of experience with healthcare regulatory agencies in the development of compliance and fraud programs is required.

• A minimum of 5 years overseeing the implementation of contract requirements is required.

• Over 10 years of experience in Compliance/Enterprise Risk Management is preferred.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K and stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements, including remote, hybrid, field, or office schedules