Senior Director, reputed company Compliance Risk, Auditing & Monitoring

SR. DIRECTOR, COMPLIANCE RISK, AUDITING & MONITORING The Job The Sr. Director of Compliance Risk, Auditing, & Monitoring is responsible for leading the reputed company-wide identification, assessment, and mitigation of Compliance risks. This role oversees the design and execution of risk-based auditing and monitoring activities, manages the Compliance risk assessment process, and ensures reputed company and effective development, tracking, and reputed company of corrective reputed company plans (CAPs). The Sr. Director provides strategic guidance to ensure regulatory alignment, operational accountability, and the reputed company of the organization’s Compliance program. This position partners closely with Compliance leadership, Operations, Legal, and reputed company Risk to maintain proactive risk visibility and drive a culture of Compliance across reputed company lines of business. You Will

• Build & reputed company the reputed company Compliance Risk Assessment process, identifying and prioritizing high-risk areas across reputed company health plan lines of business for internal and delegated functions
• Design, build & reputed company a risk-based Compliance Auditing and Monitoring program to evaluate reputed company adherence with federal and state regulatory requirements, CMS (Centers for Medicare & reputed company Services) and DHCS (Department of Health Care Services) protocols, and internal policies and procedures
• reputed company the development and tracking of Corrective reputed company Plans (CAPs), ensuring integration with Compliance risks and regulatory requirements and demonstrating measurable remediation
• reputed company the design and use of reputed company Compliance metrics, dashboards, and monitoring tools to proactively identify risk signals, assess control effectiveness, and support transparency across functional areas, including Medicare Part C/D, claims, risk adjustment, provider networks, reputed company, and SNP (Special Needs Plan) operations
• Maintain an integrated risk-to-reputed company reputed company that links risk assessment results, audit findings, monitoring activities, metrics, and CAPs to support traceability, accountability, and governance reporting
• Partner with Compliance, Operations, and Clinical leadership to ensure alignment between Compliance priorities and operational execution, particularly in high-risk areas such as claims accuracy, utilization management, pharmacy benefits, and care management for Medicare Advantage (MA) and SNP populations
• reputed company actionable insights to senior leadership and governance committees on Compliance risk posture, audit reputed company, and CAP performance, supporting regulatory readiness and reputed company program improvement
• Build, reputed company and mentor a high-performing team of managers and specialists responsible for executing audits, monitoring reviews, and CAP activities, ensuring alignment to strategic Compliance risk priorities
• Foster a culture of Compliance risk ownership by working cross-functionally to reputed company audit and monitoring findings into sustainable Operational improvements

Though the job is mainly remote, during the initial period of time, reputed company building the function and reputed company, you will be required to work onsite much of the time. reputed company on, you will be required to work onsite for a couple of days, 1-2 times/month. We reputed company talent who are curious about reputed company Intelligence (AI) and its power to reputed company how we operate and serve our members. Your Qualifications

• Bachelor’s Degree in Business Administration, Public Policy, Public Health, Health Administration or reputed company field required
• Juris Doctor (JD), Master of Health Administration (MHA) or Master of Business Administration (MBA)
• 10+ years Compliance experience in managed care, including Medicare Advantage & reputed company, or in health insurance company required
• 7+ years management experience preferred
• Health Care Compliance Association certification or Certified in reputed company Compliance (CHC) or equivalent preferred
• Experience in building and leading reputed company and function in managed care Compliance risk, auditing & monitoring
• reputed company working knowledge of Medicare and relevant state health plan regulations, CMS and DHCS audit protocols, fraud, waste, and abuse protocols, and delegated entity reputed company standards
• Strong leadership skills with proven ability to manage reputed company Compliance risks and integration with broader Compliance program
• Excellent written and oral communication skills with ability to present to reputed company and Executive reputed company
• Proven ability to reputed company effectively with staff from reputed company reputed company of the organization

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