Director, Compliance & Regulatory Risk

CareSource Management Services; Massachusetts; Hybrid; USD 140,000 - 210,000; Full time

Job summary

CareSource seeks a Director of Compliance to establish baselines for compliance risk, align strategies with corporate goals, and execute a comprehensive compliance program for applicable government programs.

The role requires leading regulatory engagement, improving audit readiness, and driving risk mitigation through testing, reporting, and collaboration across business units. Strong leadership and deep regulatory knowledge are essential.

Qualifications

• Bachelor's degree required
• MBA/JD or advanced degree preferred
• 5+ years of relevant work experience in health plan operations
• 3+ years of management experience required
• CMS program experience (Medicare/Medicaid/Marketplace) preferred

Responsibilities

• Serve as program compliance officer for assigned CareSource program and maintain relationships with regulatory entities
• Assist CCO with implementation of effective compliance program
• Oversee regulatory guidance changes and regulator requests, audits, investigations, and remediation
• Build partnerships with business units to ensure compliance requirements are met and risk is monitored
• Interpret and implement federal/state laws regarding Medicaid, Medicare, and Marketplace as applicable
• Provide insights for annual compliance work plan and risk assessment activities
• Manage compliance tools and data for tracking systems
• Oversee corrective action plans, monitoring, and annual audits
• Develop reporting on compliance metrics and trends for committees and leadership
• Perform data analysis and reporting; maintain oversight reporting mechanisms
• Alert leadership to potential risks and remediation opportunities
• Assist with regulatory audits and audit readiness
• Collaborate on distribution of compliance alerts and educational materials
• Foster a culture of compliance aligned with CareSource values

Skills

Regulatory compliance

Leadership

Stakeholder management

Communication

MS Office

Education

Bachelor's degree in Business/Healthcare Administration

MBA or JD preferred

Tools

MS Office Suite

Job description

CareSource seeks a Director of Compliance to establish baselines for compliance risk, align strategies with corporate goals, and execute a comprehensive compliance program for applicable government programs.

The role requires leading regulatory engagement, improving audit readiness, and driving risk mitigation through testing, reporting, and collaboration across business units. Strong leadership and deep regulatory knowledge are essential.