ABOUT THE ROLEWe are seeking an experienced
Compliance & Privacy Officer to serve as Capital Health Plan's designated Compliance Officer and Privacy Officer. This executive leadership role is responsible for providing strategic oversight of the organization's Corporate Compliance and Privacy Programs while ensuring compliance with applicable federal and state regulations, contractual obligations, accreditation standards, and organizational policies.
The Compliance & Privacy Officer partners closely with executive leadership and the Board of Directors to identify, assess, and mitigate compliance and privacy risks. This position oversees enterprise compliance initiatives, regulatory monitoring, investigations, auditing activities, privacy programs, and risk management efforts while promoting a culture of integrity, accountability, and ethical conduct throughout the organization.
WE'RE LOOKING FOR SOMEONE WHO HAS- Master's degree (MBA, MHA, MPH, or related field) or equivalent combination of education and experience.
- Four to ten years of progressively responsible experience in healthcare compliance, health plan regulatory compliance, privacy, auditing, risk management, or related disciplines.
- Strong knowledge of healthcare compliance principles, managed care regulations, and health plan operations.
- Experience conducting compliance risk assessments, auditing, monitoring, investigations, and corrective action initiatives.
- Ability to interpret complex regulatory requirements and translate them into practical guidance for leaders and operational teams.
- Excellent executive communication, presentation, and relationship management skills.
- Ability to manage highly confidential and sensitive information while exercising sound judgment and independence.
HIGHLY PREFERRED CANDIDATES ALSO HAVE- Juris Doctor (JD), Master of Healthcare Administration (MHA), Master of Business Administration (MBA), Master of Public Health (MPH), or other related advanced degree.
- Ten or more years of healthcare compliance experience.
- Experience within a health plan, managed care organization, HMO, Medicare Advantage plan, or payer environment.
- Experience interacting with Boards of Directors, Audit Committees, CMS regulators, and external auditors.
- Certification as a Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified Information Privacy Professional (CIPP), or similar professional credential.
- Experience leading enterprise compliance, privacy, auditing, risk assessment, and corrective action programs.
WHAT SUCCESS LOOKS LIKE IN THIS ROLE- Maintains an effective enterprise compliance and privacy program that meets regulatory, contractual, and accreditation requirements.
- Proactively identifies, assesses, and mitigates compliance and privacy risks.
- Provides trusted guidance to executive leadership and the Board regarding regulatory obligations and emerging risks.
- Oversees timely investigations, auditing activities, corrective actions, and privacy response processes.
- Strengthens organizational awareness of ethics, compliance, privacy, and accountability.
- Builds productive relationships with regulators, auditors, providers, executives, and business leaders.
