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Director of Healthcare Compliance, Value-Based Care & Risk Adjustment
About The Opportunity
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 is a senior compliance seat for someone who has worked inside a value-based care enabler or closely comparable model, not a broad hospital-only compliance role.
The right candidate will understand how compliance actually works when clinical teams, nurse practitioners, payer requirements, risk adjustment documentation, multi-state Medicaid obligations, privacy, quality, audits, and executive governance all intersect. You will help build and run a compliance program that supports growth while protecting patients, providers, payers, and the business.
What You Will Do
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.
What We Are Looking For
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.
Nice To Have
Experience with organizations similar to value-based care enablement, home assessment, population health, or risk adjustment platforms.
Experience supporting Medicaid compliance across multiple states.
Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), JD, MHA, MPH, MBA, or another relevant advanced credential.
Experience with CMS, NCQA, URAC, Medicaid, Medicare Advantage, HIPAA, payer, or related healthcare audits.
Experience building compliance dashboards, Board reporting, Power BI reporting, or other executive-level metrics.
Experience with M&A diligence, integration, or rapid multi-state expansion.
Experience thinking through appropriate AI usage and safeguards in a regulated healthcare environment.
Location This is a remote U.S. role with occasional travel as needed for leadership, audit, clinical, or integration work.
Compensation
The expected compensation range is $140,000 to $160,000 base salary, plus a bonus tied to successful audits and compliance outcomes.
Interview Process
Qualified candidates will complete a video interview with Urrly focused on value-based care compliance depth, Medicare Advantage and Medicaid exposure, clinical/provider compliance, investigations, audit readiness, governance, executive communication, and compensation/logistics alignment. Strong candidates may then be introduced to the client team for additional conversations.
Apply
Apply now and get a response within 24 hours.
Salary: $140,000 – $160,000 / year Originally posted on Himalayas
