Senior Director, Compliance Officer

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

📋 Description

• Develop, implement, and manage a thorough compliance program that aligns with both federal and state healthcare regulations, including CMS, HIPAA, and specific managed care requirements at the state level.

• Oversee compliance with contractual obligations pertaining to delegated services across various specialties, which include claims, call center operations, and/or medical management.

• Act as the Organization’s HIPAA Privacy Official and collaborate with the appointed HIPAA Security Official.

• Serve as the main point of contact for regulatory agencies and health plan partners on compliance issues.

• Lead internal audits and conduct risk assessments.

• Design and deliver compliance training sessions for employees, providers, and contractors.

• Investigate and address compliance concerns, allegations of misconduct, and violations of regulatory standards.

• Work alongside operational leaders to incorporate compliance into business processes and strategic goals.

• Prepare and present compliance reports to the General Counsel and the Board of Directors.

• Provide guidance to leadership on changing healthcare regulations and industry best practices.

• Supervise compliance policies and procedures.

• Oversee the preparation and adherence to the Compliance department budget.

• Chair the Compliance Committee and its associated subcommittees.

• Coordinate the oversight of affiliated contractors and delegates.

• Enhance and sustain a program focused on the prevention, detection, and operational management of Fraud, Waste, and Abuse.

⛳️ Requirements

• A Bachelor’s degree is required.

• A minimum of 8 years of experience in healthcare compliance, ideally within managed care or delegated service organizations.

• Extensive knowledge of CMS, HIPAA, and state Medicaid/Medicare regulations.

• Experience with delegated services and provider networks is essential.

• Demonstrated ability to lead cross-functional teams and drive organizational change.

• Outstanding communication and presentation skills, particularly in reporting to executive leadership and boards.

• Strong analytical and problem-solving capabilities.

• Certification in Healthcare Compliance (CHC) or a similar credential is preferred.

• Experience with compliance technology platforms and data analytics is preferred.

🏝️ Benefits

• Competitive salary and performance-based bonuses.

• Comprehensive health, dental, and vision insurance.

• Retirement savings plan with employer matching.

• Generous paid time off and holiday schedule.

• Opportunities for professional development and continuous learning.