Strategic Health Plan Compliance Leader

Community Hospital of the Monterey Peninsula (CHOMP); Monterey (CA); On-site; USD 140,000 - 190,000; Full time

Job summary

Aspire Health, in collaboration with Montage Health, seeks a seasoned Compliance Leader to plan, design, implement, and refine the Compliance Program. You will coordinate audits, address CMS/DMHC requirements, and drive staff training and awareness aligned with state and federal law.

Ideal candidates have deep expertise in HIPAA, NCQA guidelines, and managed care contracting, with strong communication and cross-functional collaboration skills.

Qualifications

• Minimum 7 years’ experience in health plans.
• 3-5 years management experience.

Responsibilities

• Serve as primary contact with CMS and DMHC in California.
• Coordinate regulatory audits, and prepare compliance reports for the Board and Executive Management.
• Develop and submit CMS HPMS and DMHC filings/certifications.
• Monitor KPIs and deploy internal audits to detect non-compliance.

Skills

Compliance management

Regulatory knowledge

HIPAA compliance

Audit techniques

Communication skills

MS Office

Education

Advanced degree in health administration / law / business law

CHC/CIA or equivalent certification preferred

Tools

HPMS portal

DMHC portal

Job description

Aspire Health, in collaboration with Montage Health, seeks a seasoned Compliance Leader to plan, design, implement, and refine the Compliance Program. You will coordinate audits, address CMS/DMHC requirements, and drive staff training and awareness aligned with state and federal law.

Ideal candidates have deep expertise in HIPAA, NCQA guidelines, and managed care contracting, with strong communication and cross-functional collaboration skills.