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

About the role

Lead enterprise compliance for a fast‑growing healthcare organization operating at the center of value‑based care, population health, Medicare Advantage, Medicaid, risk adjustment, and home‑based clinical operations. This senior seat requires deep experience in a value‑based care enablement model.

Key responsibilities

• Lead and strengthen the enterprise compliance program across corporate and clinical functions.
• Maintain policies, standards, procedures, evidence, reporting, and governance aligned with OIG guidance and applicable federal and state requirements.
• Conduct compliance risk assessments and develop annual work plans.
• Monitor regulatory changes and translate them into practical operating requirements.
• Lead internal investigations, root‑cause analysis, corrective action plans, and follow‑through.
• Partner with Clinical Operations, Legal, HR, Information Security, Revenue Cycle, Quality, Credentialing, and Executive Leadership.
• Support compliance with Medicare Advantage, Medicaid, CMS, telehealth, payer, and risk‑adjustment requirements.
• Monitor clinical and provider compliance, including nurse practitioner scope of practice, licensure, credentialing, privileging, and enrollment.
• Participate in CMS, Medicare Advantage, Medicaid, HIPAA, NCQA, URAC, payer, and related healthcare audits.
• Develop compliance education and training for employees, providers, and leaders.
• Build executive dashboards, compliance metrics, and Board‑ready reporting.
• Support M&A, integration, and expansion diligence from a compliance perspective.

Required profile

• 7+ years of progressively responsible healthcare compliance experience, with at least 3 years in a leadership role.
• Direct compliance experience in value‑based care, population health, risk adjustment, Medicare Advantage, Medicaid, or comparable environments.
• Strong working knowledge of OIG Compliance Program Guidance, CMS requirements, HIPAA, Fraud, Waste & Abuse, Stark Law, Anti‑Kickback Statute, telehealth regulations, and nurse practitioner scope‑of‑practice requirements.
• Proven ability to lead internal investigations, audits, regulatory inquiries, and corrective action plans.
• Experience managing both corporate and clinical compliance programs in a multi‑state organization.
• Excellent executive communication, judgment, documentation, and cross‑functional leadership skills.

Required skills

• Power BI reporting and dashboard creation.
• AI usage and safeguards in regulated healthcare environments.