VP, Compliance

🕒 Junho 4

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Abby Care

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

👥 B2C

Healthcare Insurance • B2C

A Abby Care é um serviço que ajuda famílias a serem remuneradas por fornecerem cuidados domiciliares a entes queridos com deficiências ou necessidades especiais. A organização oferece treinamento e certificação gratuita para cuidadores familiares, gerencia contratações e folha de pagamento, orienta em relação à papelada do Medicaid e de seguros para garantir o pagamento, além de proporcionar uma plataforma desenvolvida para esse fim, suporte clínico e recursos comunitários. A Abby Care opera em vários estados dos EUA e se concentra em possibilitar o cuidado familiar de alta qualidade e remunerado, por meio de parcerias com seguradoras e programas Medicaid.

Descrição

• Design, build, deploy, and continuously improve a comprehensive enterprise compliance program covering every aspect of Abby Care's healthcare operations, anchored to the OIG seven-element framework and the DOJ's Evaluation of Corporate Compliance Programs guidance. • Set the company's compliance strategy and priorities, including the annual enterprise risk assessment, multi-year work plan, audit and monitoring calendar, and annual program effectiveness review; secure the resourcing and Board endorsement to execute against them. • Establish and operate the program's full operational backbone — policies and procedures, training and culture, reporting and hotline channels, monitoring and auditing, investigations, discipline, and corrective action — and ensure each element is functioning, measurable, and improving. • Lead compliance across the full program lifecycle, clinical operations, documentation, billing and coding, EVV, payor and MCO contract performance, and program integrity; and work to build a culture of compliance by embedding compliance into how the business runs rather than bolting it on. • Lead regulatory change management across the federal stack (AKS, Stark, FCA, HIPAA/HITECH, CMS, OIG, HRSA, and the 21st Century Cures Act) and across each state Medicaid environment in which we operate. • Manage all government inquiries, audits, investigations, self-disclosures, and any settlement or CIA obligations; serve as the company's principal compliance liaison to regulators, MCO program integrity functions, and external counsel. • Partner with Legal, People, Operations, Clinical Leadership, Information Security, and Finance to embed compliance controls across the workforce, software and vendor ecosystem, and care delivery model. • Partner with the General Counsel on compliance initiatives regarding AI governance and the deployment of AI in clinical and operational workflows, including FDA SaMD/CDS analysis, documentation integrity, and patient-facing disclosures. • Lead compliance diligence and integration for new market entry, new Medicaid program design, new service lines, and M&A activity. • Serve as the company's designated Compliance Officer; chair the Compliance Committee; report regularly to the Board on risk posture, incidents and program effectiveness, with independent access as needed. • Build, hire, and develop a high-performing in-house compliance team, investigations, auditing and monitoring, training, and compliance operations and analytics, and the technology infrastructure that supports a modern program.

🎯 Requisitos

• 10+ years of progressively senior compliance experience at a healthcare company, including 5+ years at the Director level or above. • A track record of designing and building, or materially rebuilding and scaling, an enterprise compliance program, not solely operating an established one. • Demonstrated end-to-end ownership across all seven OIG compliance program elements, not partial ownership of one or two pillars. • Substantial experience at companies funded by government healthcare programs (Medicaid, Medicaid waivers, Medicare, and managed Medicaid). • Working command of the federal healthcare regulatory stack (AKS, Stark, FCA, HIPAA/HITECH, CMS and OIG guidance) and of state Medicaid program integrity requirements. • Multi-state operating experience and the range to manage a comprehensive, systems-based program across several state Medicaid environments simultaneously. • High judgment on risk tradeoffs, strong written communication, and the credibility to take and defend a position with executives, the Board, and regulators. • Comfort operating in a fast-growth environment with imperfect data, competing priorities, and the need to write the policy yourself before handing it off.

🏖️ Benefícios

• Health insurance • Remote work options • Professional development opportunities