Site: Mass General Brigham Health Plan Holding Company, Inc.
Responsible for the strategic leadership, design, and oversight of the organization's enterprise compliance program across all lines of business, including Commercial, Medicaid, Medicare Advantage, and Dual Eligible Special Needs Plans (DSNP). Ensures the organization maintains full compliance with all applicable federal and state regulatory requirements while fostering a culture of ethics, integrity, and accountability.
This role provides executive leadership for compliance governance, risk mitigation, auditing and monitoring, and regulatory engagement, and partners closely with senior leadership and the Board of Directors to ensure proactive identification and management of compliance risks.
QualificationsPrinciple Responsibilities:Enterprise Compliance Strategy & Program Leadership- Develop and lead a comprehensive, enterprise-wide compliance program aligned with regulatory requirements and business strategy.
- Establish and maintain compliance governance structures, including executive-level committees and Board of Directors reporting.
- Ensure integration of compliance across all lines of business (Commercial, Medicaid, Medicare Advantage, DSNP).
- Drive continuous improvement of the compliance framework in response to regulatory changes and organizational priorities.
Regulatory Oversight & Risk Management- Provide oversight of compliance with federal and state healthcare regulations, including CMS, Medicaid, and commercial requirements.
- Lead enterprise risk assessment processes to identify, prioritize, and mitigate compliance risks.
- Ensure alignment with accreditation standards and regulatory expectations across all products.
- Stay current on regulatory changes and proactively guide operational leadership on implications.
Audit, Monitoring & Investigations- Oversee enterprise compliance auditing and monitoring activities, including vendor and FDR oversight where applicable.
- Ensure implementation of corrective action plans and validation of remediation effectiveness.
- Lead or oversee investigations into potential compliance violations, coordinating with Legal as appropriate.
- Ensure reporting mechanisms (e.g., hotline, internal reporting) are effective and trusted.
Policies, Training & Culture- Establish and maintain enterprise compliance policies and standards.
- Lead development and execution of compliance education and training programs across all employee populations.
- Partner with Learning & Development on training program training creation and delivery.
- Promote a culture of compliance, ethics, and accountability across the organization.
- Ensure leaders are equipped to operationalize compliance requirements within their functions.
Leadership, Governance & Stakeholder Management- Serve as a trusted advisor to executive leadership on compliance and regulatory matters.
- Present compliance program performance, risks, and key issues to executive leadership and the Board of Directors.
- Act as primary liaison with regulatory agencies during audits, reviews, and investigations.
- Partner cross-functionally with Legal, Operations, Clinical, Finance, and HR to ensure compliance integration.
People Leadership- Build, lead, and develop a high-performing compliance organization, including regulatory, Medicare/Medicaid compliance, and audit functions.
- Establish clear goals, performance expectations, and talent development strategies.
- Foster an inclusive, high-accountability culture aligned with organizational values.
- Hold self and others accountable to meet commitments.
- Focuses on collaboration and connection to contribute to a high performing workplace.
- Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
- Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
- Other duties as assigned with or without accommodation.
Qualifications:- Bachelor's degree in Healthcare Administration, Public Health Law, Business or related field required or the equivalent combination of training and experience, plus 12+ years of related experience.
- Master's degree or JD strongly preferred.
- 12+ years of progressive experience in healthcare compliance, regulatory affairs, or risk management
- 7+ years of leadership experience in a complex, multi-line healthcare organization or health plan
- Deep expertise across government programs (Medicare Advantage, Medicaid, DSNP) and commercial products
- Experience interacting with regulatory agencies and leading audits and investigations
The salary range for this position is $250,000.00 to $300,000.00 annually. At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience, if applicable, education, certifications, and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package.
In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums, and bonuses as applicable, and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
Additional Job Details (if applicable)Remote TypeHybrid
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
