Compliance Manager

Alivi Health

Miami (FL)

On-site

USD 102,000 - 138,000

Full time

14 days+

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Benefits offered by this job

401(k)

Health insurance

Paid time off

Vision insurance

Job summary

Alivi Health is seeking a Compliance and Risk Manager to oversee enterprise-wide compliance and risk management programs, ensuring adherence to federal, state, and health plan requirements. The role includes audits, risk assessments, and partnering with cross-functional teams to strengthen integrity and regulatory compliance.

The position requires a Bachelor’s degree in a related field, 3–7 years of experience, and strong knowledge of HIPAA, CMS, OIG, and OSHA regulations.

Qualifications

Bachelor’s degree in a related field required.
Located in Miami, FL or surrounding area.
3–7 years of experience in compliance, risk management, audit, legal, or regulatory affairs.
Strong knowledge of federal and state regulatory frameworks (HIPAA, CMS, OIG, OSHA).
High level of integrity, professionalism, and discretion.
Ability to present information clearly and respond to questions.

Responsibilities

Oversee the organization’s enterprise-wide compliance program for clinical and nonclinical benefits.
Lead audits and responses for health plans and external/regulatory audits.
Conduct enterprise risk assessments and maintain the risk register.
Perform investigations into policy violations, regulatory risks, or operational failures.
Oversee contractors, subcontractors, transportation providers, and clinical networks for compliance.
Prepare compliance reports, board updates, and risk dashboards.

Skills

Analytical skills

Investigative skills

Problem-solving

Communication

Integrity

Education

Bachelor’s degree in Business, Healthcare Administration, Risk Management, Legal Studies, or related field

Certified Professional in Healthcare Compliance (CPHC) or CHC (preferred)

Job description

Pay:$120,000.00 per year

Job description:

SUMMARY

The Compliance and Risk Manager is responsible for overseeing the organization’s enterprise-wide compliance and risk management programs, ensuring adherence to federal, state, and health plan requirements, as well as internal policies and industry standards. This role manages the full compliance framework for both clinical and nonclinical benefit programs—including Non-Emergency Medical Transportation (NEMT), Podiatry, Acupuncture, Chiropractic, Therapy, Optometry, Ophthalmology, and additional specialty care services.

The Compliance and Risk Manager conduct internal audits, leads external and health plan audit responses, manages risk assessments, and partners with cross functional teams to strengthen organizational integrity, operational excellence, and regulatory compliance.

DUTIES & RESPONSIBILITIES

Regulatory Compliance

Oversee the organization’s compliance program for all clinical and nonclinical benefits, including NEMT, ancillary care, specialty care, and provider delivered benefits.
Monitor regulatory updates and communicate new or changing compliance requirements across operational departments.
Maintain, update, and enforce compliance policies, procedures, and training programs.
Provide guidance to leadership and business units to ensure alignment with federal, state, Medicaid Managed Care, Medicare Advantage, and commercial health plan obligations.

Audit Oversight – Health Plans & External Audits

Serve as the primary point of contact for all health plan audits, external regulatory audits, accreditation reviews, and delegated oversight audits.
Lead audit preparation, document collection, corrective action plans, and remediation tracking.
Coordinate responses to inquiries from state agencies, plan partners, regulators, and accreditation bodies.
Ensure timely, accurate, and compliant audit submissions across all service lines and business functions.

Risk Management

Conduct enterprise risk assessments and maintain the organization’s risk register.
Identify emerging risks in operations, claims processing, vendor management, and program integrity.
Develop and monitor risk mitigation strategies in collaboration with internal stakeholders.

Investigations & Issue Management

Conduct investigations involving potential policy violations, regulatory risks, fraud/waste/abuse concerns, or operational failures.
Coordinate with Legal, HR, and operational teams as appropriate to ensure proper resolution.
Document all findings, root causes, and remediation outcomes.

Vendor & Third-Party Oversight‑Party Oversight

Oversee compliance obligations for contractors, subcontractors, transportation providers, and clinical networks.
Support credentialing verification, exclusion screening compliance, and risk scoring of third-party entities.
Conduct and oversee delegated vendor audits, corrective action plans, and ongoing monitoring.

Documentation & Reporting

Prepare compliance reports, board level updates, audit summaries, and risk dashboards.
Maintain comprehensive documentation related to audits, investigations, policies, training, and mitigation activities.
Support regulatory submissions as required.

Program Development & Continuous Improvement

Assist in strategic planning and development of enhancements to the compliance and risk programs.
Promote a culture of compliance through training, communication, and proactive risk prevention initiatives.
Identify opportunities to streamline compliance processes and strengthen oversight.
Oversees and provides direct supervision to the Compliance, Fraud, Waste and Abuse (FWA), and Grievances and Appeals team to ensure regulatory adherence and operational effectiveness.

REQUIREMENTS & QUALIFICATIONS

Bachelor’s degree in Business, Healthcare Administration, Risk Management, Legal Studies, or related field required.
Located in Miami, FL, or surrounding areas.
Certified Professional in Healthcare Compliance (CPHC or CHC) preferred.
3–7 years of experience in compliance, risk management, audit, legal, or regulatory affairs.
Strong knowledge of federal and state regulatory frameworks (e.g., HIPAA, CMS, OIG, OSHA).
Exceptional analytical, investigative, and problem‑solving abilities.
High degree of integrity, professionalism, and discretion.
Ability to effectively present information and respond to questions.

Benefits