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

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee enterprise compliance for a rapidly expanding healthcare organization engaged in value-based care, population health, Medicare Advantage, Medicaid, risk adjustment, and home-based clinical operations.

• Enhance and lead the enterprise compliance program that encompasses both corporate and clinical compliance.

• Ensure policies, standards, procedures, documentation, reporting, and governance are consistent with OIG guidance and relevant federal and state healthcare regulations.

• Perform compliance risk assessments and assist in developing annual compliance work plans.

• Keep abreast of regulatory changes and convert them into actionable operating requirements.

• Direct internal compliance investigations, conduct root-cause analyses, develop corrective action plans, and ensure follow-through.

• Collaborate with Clinical Operations, Legal, HR, Information Security, Revenue Cycle, Quality, Credentialing, and Executive Leadership.

• Facilitate compliance with Medicare Advantage, Medicaid, CMS, telehealth, payer, and risk adjustment regulations.

• Supervise clinical and provider compliance, which includes nurse practitioner scope of practice, collaboration agreements, supervision requirements, licensure, credentialing, privileging, and enrollment.

• Assist in HIPAA Privacy and Security initiatives in cooperation with Information Security.

• Engage in CMS, Medicare Advantage, Medicaid, HIPAA, NCQA, URAC, payer, and other healthcare audits.

• Create compliance education and training programs for employees, providers, and leaders.

• Develop executive dashboards, compliance metrics, and reporting suitable for the Board.

• Provide compliance support during M&A, integration, and expansion diligence when necessary.

⛳️ Requirements

• Proven compliance experience in value-based care, population health, risk adjustment, Medicare Advantage, Medicaid, home-based care, or a similar healthcare enablement setting.

• A minimum of 7 years of progressively responsible healthcare compliance experience.

• At least 3 years in a leadership role within compliance.

• A progressive and clear compliance career trajectory with increasing responsibilities, stable tenure, and current or recent experience in a relevant healthcare setting.

• Expertise in managing both corporate and clinical compliance programs.

• Comprehensive understanding of OIG Compliance Program Guidance, CMS regulations, Medicare Advantage, Medicaid, HIPAA, Fraud, Waste & Abuse, Stark Law, Anti-Kickback Statute, telehealth regulations, provider licensure, credentialing, and nurse practitioner scope-of-practice standards.

• Experience leading internal investigations, audits, regulatory inquiries, and corrective action initiatives.

• Capability to translate complex regulatory requirements into practical operational processes.

• Exceptional executive communication skills, sound judgment, thorough documentation, and cross-functional leadership abilities.

• Comfortable operating within a dynamic, multi-state healthcare organization where compliance must be both stringent and practical.

🏝️ Benefits

• Bonuses linked to successful audits and compliance results.