Senior Director, Compliance Officer

Job not on LinkedIn

🔥 5 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $165k - $180k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

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Health Network One

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Health Network One is a healthcare network management company that partners with health plans to manage specialty outpatient services (including outpatient therapy, routine and medical eye care, dermatology, and podiatry) under full-risk arrangements. The company operates nationally, covering over 7 million lives and contracting with tens of thousands of providers, and offers delegated services such as utilization management, credentialing, claims and network management. Health Network One emphasizes value‑based solutions, clinical quality, cost reduction for professional and facility spend, and holds NCQA accreditation and HITRUST CSF certification.

📋 Description

• Develop, implement, and oversee a comprehensive compliance program aligned with federal and state healthcare regulations, including CMS, HIPAA, and state-specific managed care requirements • Monitor compliance with contractual obligations related to delegated services across specialties, including claims, call center, and/or medical management operations • Serve as the Organization’s HIPAA Privacy Official and coordinate with the designated HIPAA Security Official • Act as primary liaison with regulatory agencies and health plan partners regarding compliance matters • Lead internal audits and risk assessments • Develop and deliver compliance training for employees, providers, and contractors • Investigate and resolve compliance issues, misconduct allegations, and regulatory violations • Collaborate with operational leaders to integrate compliance into business processes and strategic initiatives • Prepare and present compliance reports to the General Counsel and Board of Directors • Advise leadership on evolving healthcare regulations and industry best practices • Oversee compliance policies and procedures • Manage Compliance department budget preparation and adherence • Chair the Compliance Committee and related subcommittees • Coordinate oversight of affiliated contractors and delegates • Enhance and maintain a Fraud, Waste, and Abuse prevention, detection, and operations program

🎯 Requirements

• Bachelor’s degree required • Minimum of 8 years of experience in healthcare compliance, preferably within managed care or delegated service organizations • Deep understanding of CMS, HIPAA, and state Medicaid/Medicare regulations • Experience working with delegated services and provider networks • Proven ability to lead cross-functional teams and influence organizational change • Exceptional communication and presentation skills, including reporting to executive leadership and boards • Strong analytical and problem-solving skills • Certification in Healthcare Compliance (CHC) or similar credential preferred • Experience with compliance technology platforms and data analytics preferred