Head of Compliance

Responsibilities

Regulatory & Corporate Compliance

• Own compliance strategy and risk assessment, including entity structure, state-by-state licensure, and corporate practice of medicine (CPOM) requirements.
• Build government programs compliance capabilities, including Medicare marketing and member communication requirements.
• Own compliance governance, including Compliance Committee preparation, leadership reporting, risk themes, action tracking, and escalation.
• Manage privacy and HIPAA compliance operations, including policy maintenance, incident response, investigations, training, and collaboration with Legal and Security.

Clinical Compliance

• Centralize and standardize compliance for care management and clinical program designs, including SOPs and documentation.
• Embed compliance into clinical, product, operations, data, payer-facing, technology, AI-enabled, and market expansion workflows.
• Support credentialing oversight with Clinical leadership.

IT & Security Compliance

• Partner with Security on training programs, SOC 2, HITRUST, and related certifications.

Internal Audit

• Establish and run an internal audit function with policy review, SOP verification, and ongoing risk monitoring.
• Create processes for compliance intake, investigations, root-cause analysis, remediation tracking, and resolution of concerns, incidents, and complaints.

First 90 Days

• Serve as the designated compliance lead for the direct contract with the Centers for Medicare and Medicaid Services.
• Clarify ownership, escalation paths, and immediate compliance priorities.
• Create a centralized GDMT compliance framework with SOPs, documentation standards, and operating rhythms.
• Launch a practical internal audit process tied to key risk areas.
• Deliver a leadership-ready risk assessment across regulatory, clinical, and government programs compliance.

Requirements

• 10+ years of healthcare compliance leadership experience in value-based care, managed care, population health, or another payer-facing care model.
• Deep knowledge of HIPAA and privacy, CPOM, fee splitting, licensing, credentialing, AKS/FWA, the False Claims Act, and Medicare and Medicaid requirements.
• Hands-on experience with Medicare, Medicaid, ACOs, and related CMS requirements.
• Experience building practical compliance programs, including policies, training, monitoring, audits, and risk-based controls.
• Ability to operate in early-stage, multi-state environments where priorities evolve and processes must be built from scratch.
• Strong judgment and cross-functional leadership skills, with the ability to partner across legal, clinical, security, and business teams.

Compensation & Benefits

• Remote, US-based role.
• Preference for candidates in the Eastern Time zone or able to work Eastern Time hours.
• Periodic travel to practice sites or company offices may be required.