Employment Type: Direct Hire
Location: On-site, Orange County, CA
Description:The Medicare Compliance Director is responsible for overseeing the development, implementation, and monitoring of the Medicare Advantage compliance program. This role ensures adherence to applicable Centers for Medicare & Medicaid Services (CMS) requirements, federal regulations, and healthcare laws while supporting effective compliance operations across the organization.
The Medicare Compliance Director will coordinate audits, risk assessments, corrective action plans, compliance training, investigations, regulatory reporting, and documentation while partnering with legal, finance, operations, and clinical teams to support compliant business processes.
What You Will Do:- Oversee and assist with the development, implementation, and monitoring of the Medicare Advantage compliance program.
- Ensure adherence to applicable CMS requirements and federal regulations.
- Manage compliance policies and procedures.
- Conduct risk assessments and internal audits.
- Monitor regulatory changes and assess their impact on Medicare Advantage operations.
- Coordinate corrective action plans related to identified compliance issues.
- Collaborate with legal, finance, operations, and clinical teams to support compliant workflows.
- Provide training and guidance on compliance standards.
- Prepare compliance reports for senior leadership and regulatory bodies.
- Lead investigations involving potential non-compliance.
- Maintain accurate and complete compliance documentation.
- Support compliance management activities related to Medicare Advantage, CMS regulations, healthcare laws, and internal auditing.
- Evaluate audit findings and support development of appropriate mitigation strategies.
- Promote a culture of integrity and accountability throughout the organization.
You Will Be Successful If:- You can interpret and apply CMS regulations and related healthcare laws within a Medicare Advantage environment.
- You can effectively lead and manage compliance programs.
- You can conduct risk assessments and evaluate internal audit findings.
- You can develop and coordinate corrective action plans in response to identified compliance risks.
- You can analyze compliance findings and develop data-driven mitigation strategies.
- You can effectively communicate compliance requirements to operational, clinical, legal, and financial stakeholders.
- You can provide compliance training and influence cross-functional teams.
- You maintain strong attention to detail and organized compliance documentation.
- You can manage multiple priorities in a fast-paced, mission-driven environment.
- You demonstrate strong communication, presentation, and interpersonal skills.
What You Will Bring:- Demonstrated expertise in Compliance Management and Regulatory Compliance within Medicare Advantage or health plan environments.
- Strong Legal Compliance background with the ability to interpret and apply CMS regulations and related healthcare laws.
- Advanced analytical skills to conduct risk assessments, evaluate audit findings, and develop data-driven mitigation strategies.
- Working knowledge of Finance as it relates to Medicare plan operations, including the impact of compliance requirements on financial performance.
- Relevant bachelor's degree.
- Proven experience leading compliance programs.
- Experience managing audits.
- Experience interacting with regulators or external reviewers.
- Excellent communication, presentation, and interpersonal skills.
- Ability to train and influence cross-functional teams.
- Strong organizational skills and attention to detail.
- Ability to manage multiple priorities in a fast-paced, mission-driven environment.
Preferred Qualifications:
- Advanced degree such as JD, MHA, MPH, or MBA.
- Compliance certification such as CHC or CHPC.
