Director of Corporate Compliance and Privacy

MetroPlusHealth; New York (NY); Teletrabalho; USD 180 000 - 240 000; Tempo integral

Resumo da oferta

MetroPlusHealth in New York seeks a Director of Corporate Compliance and Privacy to lead strategic oversight of Compliance, Privacy, Vendor Compliance, and Behavioral Health Parity programs, reporting to the Vice President of Compliance. You will ensure programs align with federal and state requirements and promote a culture of ethics.

The role manages investigations, CAPs, risk assessment, governance, and training, with a focus on effective controls and collaboration across the organization.

Qualificações

• Bachelor’s degree in a health-related field, business, public administration, or related discipline; Master’s preferred.
• Minimum 7 years in healthcare compliance, preferably within a managed care environment.
• Experience in health insurance plans, Medicaid/Medicare, and HIPAA knowledge.
• Expertise in privacy regulations, vendor/delegation oversight, and FWA compliance.
• Experience with regulatory audits, investigations, and enterprise programs.
• Strong analytical, organizational, and communication skills.
• Proficiency with Microsoft Office and compliance tracking systems.

Responsabilidades

• Provide strategic and operational oversight of Corporate Compliance, Privacy, Vendor Compliance, and Behavioral Health Parity programs.
• Assess departmental operations; identify risks and implement improvements.
• Oversee investigations, documentation, resolution, and escalation of trends.
• Track issues to advise corrective actions and governance.
• Respond to inquiries on compliance, privacy, and FWA matters.
• Lead risk assessments and annual work plans in collaboration with Product Compliance.
• Oversee CAP development, remediation validation, and issue resolution.
• Direct oversight of vendor delegation activities and governance meetings.
• Maintain relationships with SIU and delegated vendors; coordinate investigations.
• Prepare and present reports for internal governance committees.
• Develop and monitor internal controls to ensure regulatory compliance.
• Lead training programs on compliance, privacy, and FWA.
• Provide leadership and performance management to staff.
• Promote a culture of compliance and continuous improvement.

Conhecimentos

Regulatory compliance

Privacy compliance

FWA oversight

Leadership

Audits

Stakeholder mgmt

HIPAA

Vendor oversight

Formação académica

Bachelor's degree in health-related field

Master's degree preferred

Ferramentas

MS Office

Compliance tracking systems

Descrição da oferta de emprego

Position Overview

Empower. Unite. Care.

MetroPlusHealthis committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Director of Corporate Compliance and Privacy, reporting to the Vice President of Compliance, is responsible for the strategic oversight, implementation, and ongoing effectiveness of the Corporate Compliance, Vendor Compliance, Behavioral Health Parity Compliance, and Privacy Programs.

This role leads a team of compliance professionals and is accountable for ensuring that program operations, monitoring activities, and internal controls are effective, sustainable, and aligned with applicable federal and state regulatory requirements. The Director plays a key role in promoting a culture of compliance, ethical conduct, and accountability across the organization.

Scope of Role & Responsibilities

• Provide strategic and operational oversight of the Corporate Compliance, Privacy, Vendor Compliance, and Behavioral Health Parity Compliance programs to ensure alignment with regulatory requirements and organizational priorities.
• Continually assess the effectiveness of departmental operations, including people, processes, and technology; identify risks and improvement opportunities; and implement solutions to enhance performance and compliance outcomes.
• Oversee compliance and privacy investigations, ensuring timely intake, documentation, resolution, and identification of systemic trends requiring escalation or remediation.
• Track, trend, and analyze compliance, privacy, vendor, and behavioral health parity issues to proactively identify risks and recommend corrective and preventive actions at the organizational level.
• Respond to inquiries related to corporate compliance, privacy, vendor compliance, and behavioral health parity matters, including exclusion screening, fraud, waste and abuse (FWA), and institutional policies.
• Support the enterprise compliance risk assessment and collaborate with Product Compliance to identify high-risk areas and develop annual work plan activities.
• Oversee the development, tracking, and closure of corrective action plans (CAPs), ensuring timely remediation, validation of effectiveness, and identification of systemic issues.
• Direct oversight of Vendor Compliance and delegation activities, including monitoring delegated entities, ensuring compliance with contractual and regulatory requirements, and addressing identified issues.
• Maintain strong working relationships with the Special Investigations Unit (SIU) and delegated vendors performing FWA activities, including leading recurring governance meetings and ensuring coordination on investigations and issue resolution.
• Oversee the preparation and presentation of reports for internal governance committees.
• Develop, implement, and monitor internal controls to prevent, detect, and correct non-compliance with applicable laws, regulations, and internal policies.
• Serve as an active participant on governance committees representing Corporate Compliance, Privacy, Behavioral Health Parity, and FWA concerns.
• Lead and coordinate responses to regulatory filings, reports, audits, examinations, and other oversight activities, ensuring accuracy, completeness, and timeliness.
• Monitor key program elements and ensure policies and procedures are reviewed and updated annually and as needed to remain compliant with regulatory requirements.
• Stay current with federal and state laws, regulations, and industry best practices; translate regulatory changes into actionable organizational guidance.
• Oversee the development and delivery of training programs related to compliance, privacy, behavioral health parity, and FWA to ensure workforce awareness and adherence.
• Provide direct leadership and performance management to staff.
• Promote a culture of compliance, accountability, and continuous improvement across the organization.
• Perform other activities as assigned by the Vice President or Chief Compliance and Regulatory Officer.

Required Education, Training & Professional Experience

• Bachelor’s degree in a health-related field, business, public administration, or related discipline. Master’s degree in Business Administration, Public Administration, Public Health, or related field, preferred.
• Minimum of 7 years of experience in healthcare compliance, preferably within a managed care environment.
• Experience within a health insurance plan or managed care organization.
• Strong knowledge of Medicaid, Medicare, the Affordable Care Act, and HIPAA.
• Demonstrated expertise in privacy regulations, behavioral health parity requirements, vendor/delegation oversight, and FWA compliance.
• Experience managing regulatory audits, investigations, and enterprise compliance programs.
• Strong analytical, organizational, and communication skills.
• Proficiency with Microsoft Office Suite and compliance tracking/reporting systems.

Licensure and/or Certification Preferred

• Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified Compliance & Ethics Professional (CCEP)

Professional Competencies

• Demonstrates integrit, sound judgment, and commitment to ethical conduct.
• Extensive knowledge of managed care compliance frameworks, regulatory requirements, and corporate integrity principles.
• Ability to interpret and operationalize complex regulatory and contractual requirements.
• Strong leadership and team management capabilities with experience leading cross-functional initiatives.
• Proven ability to manage multiple priorities and complex projects in a fast-paced environment.
• Excellent verbal, written, and presentation skills, including the ability to communicate effectively with senior leadership and external stakeholders.
• Strong stakeholder engagement, influencing, and negotiation skills.
• High level of discretion in handling confidential and sensitive information.
• Excellent interpersonal skills, with the ability to operate effectively within senior leadership environments.
• Proficiency in Windows-based applications, including Word, Excel, PowerPoint, SharePoint, and Visio.

This is a remote position but occasional in-person attendance may be required at the employee's expense - approximately 8 times a quarter.

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