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

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🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $140k - $160k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Urrly

WebsiteLinkedInAll Job Openings

1 - 10 employees

🎯 Recruiter

⚕️ Healthcare Insurance

🤖 Artificial Intelligence

Recruitment • Healthcare Insurance • Artificial Intelligence

Urrly is a healthcare recruitment agency that combines the expertise of healthcare recruiters, data scientists, and AI agents to help healthcare innovators secure exceptional talent quickly and affordably. Specializing in Recruitment-as-a-Service (RaaS) and Recruitment Process Outsourcing (RPO), Urrly streamlines the hiring process for U. S. healthcare companies by significantly reducing time-to-fill and cost-per-hire metrics. The company utilizes AI technology to automate administrative tasks and connect clients with top-tier candidates, providing a budget-friendly alternative to traditional recruiting agencies. Urrly's services cater to forward-thinking healthcare organizations looking to enhance their talent acquisition processes.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• Bonuses tied to successful audits and compliance outcomes