Head of Compliance

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop, implement, and oversee the Chamber’s compliance program encompassing regulatory and corporate compliance, clinical compliance, government programs, and IT/security management.

• Take ownership of the compliance strategy and risk assessment, which includes entity structure, state-by-state licensure, and corporate practice of medicine standards.

• Establish compliance capabilities for government programs, focusing on Medicare marketing and member communication requirements.

• Direct compliance governance activities, including preparation for the Compliance Committee, leadership reporting, tracking risk themes, actions, and escalations.

• Manage privacy and HIPAA compliance operations, which involve policies, incident response, investigations, training, and collaboration with Legal and Security teams.

• Standardize compliance across care management and clinical program designs, focusing on SOPs and documentation.

• Integrate compliance into workflows, programs, technologies, AI-enabled tools, and market expansion initiatives.

• Assist with credentialing oversight alongside Clinical leadership.

• Offer compliance oversight for training programs, SOC2, HITRUST, and related certifications in collaboration with Security.

• Develop and maintain an internal audit function, involving policy reviews, SOP verifications, and continuous risk monitoring.

• Create processes for intake, investigations, root-cause analysis, remediation tracking, and resolution.

• Act as the appointed compliance lead for the direct CMS contract.

• Establish a centralized GDMT compliance framework.

• Produce a risk assessment ready for leadership review across regulatory, clinical, and government programs compliance.

• Report directly to the General Counsel.

⛳️ Requirements

• Over 10 years of experience in healthcare compliance leadership.

• Background in value-based care, managed care, population health, or any payer-facing care model.

• Extensive knowledge of HIPAA/privacy, corporate practice of medicine, fee splitting, licensing, credentialing, AKS/FWA, False Claims Act, and Medicare/Medicaid regulations.

• Practical experience with Medicare, Medicaid, ACOs, and associated CMS requirements.

• Demonstrated ability to develop effective compliance programs, including policies, training, monitoring, audits, and risk-based controls.

• Capability to function in early-stage, multi-state environments where priorities change and processes need to be established from scratch.

• Strong judgment and cross-functional leadership skills working with legal, clinical, security, and business teams.

• Remote position based in the US.

• Preference for candidates in the Eastern Time zone or those who can work Eastern Time hours.

• Occasional travel to practice sites or Chamber offices may be necessary.

🏝️ Benefits

• Flexible remote work arrangement.

• Preference for candidates in the Eastern Time zone or those who can work Eastern Time hours.

• Opportunity and authority to expand the compliance function as the business scales.