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

🕒 Julho 10

🌲 North Carolina – Remoto

🌲 North Carolina – Remote

💵 $140.000 - $160.000 / ano

⏰ Tempo Integral

🔴 Especialista

🚔 Conformidade

👻 Score fantasma 22%

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Urrly

SiteLinkedInTodas as Vagas

1 - 10 funcionários

🏥 Saúde

💼 Consultoria

📦 Logística

Healthcare • Consulting • Logistics

Urrly é uma agência de recrutamento em saúde que combina a expertise de recrutadores do setor, cientistas de dados e agentes de IA para ajudar inovadores em saúde a garantir talentos excepcionais com rapidez e a custos acessíveis. Especializada em Recruitment-as-a-Service (RaaS) e Recruitment Process Outsourcing (RPO), a Urrly otimiza a contratação para empresas de saúde nos EUA, reduzindo significativamente os indicadores de time-to-fill e cost-per-hire. A empresa utiliza tecnologia de IA para automatizar tarefas administrativas e conectar clientes a candidatos de alto nível, oferecendo uma alternativa econômica às agências de recrutamento tradicionais. Os serviços da Urrly atendem organizações de saúde visionárias que buscam aprimorar seus processos de aquisição de talentos.

Descrição

• 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. • Lead and strengthen the enterprise compliance program across corporate and clinical compliance. • Maintain policies, standards, procedures, evidence, reporting, and governance aligned with OIG guidance and applicable federal and state healthcare requirements. • Conduct compliance risk assessments and help build annual compliance work plans. • Monitor regulatory changes and translate them into practical operating requirements. • Lead internal compliance 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, collaboration agreements, supervision requirements, licensure, credentialing, privileging, and enrollment. • Support HIPAA Privacy and Security initiatives in partnership with Information Security. • 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 when needed.

🎯 Requisitos

• Direct compliance experience in value-based care, population health, risk adjustment, Medicare Advantage, Medicaid, home-based care, or a comparable healthcare enablement environment. • 7+ years of progressively responsible healthcare compliance experience. • 3+ years in a compliance leadership role. • A progressive, explainable compliance career history with increasing scope, stable tenure, and current or recent work in a relevant healthcare environment. • Experience managing both corporate and clinical compliance programs. • Strong working knowledge of OIG Compliance Program Guidance, CMS requirements, Medicare Advantage, Medicaid, HIPAA, Fraud, Waste & Abuse, Stark Law, Anti-Kickback Statute, telehealth regulations, provider licensure, credentialing, and nurse practitioner scope-of-practice requirements. • Experience leading internal investigations, audits, regulatory inquiries, and corrective action plans. • Ability to translate complex regulatory requirements into practical operating processes. • Strong executive communication, judgment, documentation, and cross-functional leadership. • Comfort operating in a growing, multi-state healthcare organization where compliance needs to be both rigorous and practical.

🏖️ Benefícios

• Bonuses tied to successful audits and compliance outcomes