Director, Compliance

Shearwater Health•Nashville, TN

About The Position

The Director of Compliance serves as the senior leader responsible for establishing, overseeing, and continuously strengthening the company’s global compliance program. This role ensures adherence to U.S. healthcare regulations, privacy & security requirements, accreditation standards and client contractual requirements—while enabling operational excellence across multiple geographies. Likewise, this role provides strategic leadership in promoting a culture of compliance across all departments, mitigating risk and safeguarding organizational integrity. This leader will manage and oversee global Compliance team/resources. They will also proactively identify risk, standardizes controls, supports audit readiness, and partners closely with Operations, Quality, Training, HR, and IT to implement corrective actions as needed and embed compliance deep within service delivery. The role is critical in protecting accuracy, clinical integrity, and the company’s reputation as a trusted healthcare services partner.

Requirements

Bachelor’s degree required; advanced degree (JD, MPH, MSN, RHIA/RHIT, or related) preferred.
Minimum of 10 years of experience in healthcare compliance or regulatory oversight in a global services environment (healthcare BPO strongly preferred).
Deep understanding of CMS regulations, payer policies, utilization management rules, and regulatory/accreditation standards.
Experience leading audits, delegated UM reviews, or clinical compliance functions.
Strong command of HIPAA, data privacy regulations, and PHI/PII handling in offshore settings.
Exceptional communication, analytical, problem-solving and ability to lead cross-functional teams.
Ability to travel domestically and internationally is required.
Integrity: Holds self and others to the highest ethical standards; promotes a speak-up culture.
Healthcare Expertise: Brings authoritative knowledge on coding, UM, and regulatory requirements.
Influence & Partnership : Collaborates effectively with global leaders and clients.
Risk Anticipation : Identifies vulnerabilities early and drives preventative solutions.
Operational Excellence : Builds controls that are practical, scalable, and aligned with high-volume service delivery.

Nice To Haves

Experience supporting HITRUST, ISO, or SOC2 compliance preferred.
Demonstrated success building compliance programs within a multi-country delivery model preferred.

Responsibilities

Regulatory Compliance Lead the design, execution and management of the compliance framework which includes drafting, reviewing and updating compliance policies and procedures, leading training and education initiatives, investigating potential compliance issues and serving as the primary liaison with regulatory agencies and our client’s compliance lead(s)/ department.
Implement and maintain a comprehensive compliance program and controls that align with HIPAA, CMS, OIG, contract requirements, regulatory/accreditation standards and organizational goals.
Manage the Utilization Review (UR) Licensure process which includes determining when state UR licensure required, facilitate and oversee UR licensure submission and renewal process.
Oversee adherence to HIPAA, data privacy laws (GDPR, PDPA), and secure handling of PHI across global operations.
Maintain up-to-date knowledge of applicable laws, regulations, state boards of nursing requirements and client contract changes and drive timely operational updates.
Partner with Operations and Quality teams to establish policies, SOPs, standards, workflows, and documentation protocols that adhere with applicable requirements and standards.
Communicate compliance policies/procedure updates and ensure policies/procedures are accessible to all staff.
Collaborate with the Training team to embed compliance into onboarding, upskilling, and continuing education programs for staff.
Lead internal compliance audits across departments to monitor adherence with policies/procedures and proactively identify risks/opportunities.
Serve as the primary liaison for client audits (i.e pre-delegation and annual audits) and external reviews/audits.
Conduct risk assessments across departments.
Develop mitigation plans, monitor remediation and ensure appropriate controls in place to sustain compliance.
Track, trend and monitor corrective action plans (CAPs) to closure.
Track, trend, and report audit outcomes and present recommendations to leadership.
Oversee investigation of compliance concerns related to privacy incidents or deviations from client protocols.
Ensure appropriate documentation, root cause analysis, and resolution actions.
Partner with Legal and HR on sensitive investigations requiring cross-functional coordination.
Support client implementations and ongoing governance by reviewing compliance expectations, contractual requirements, and delegated responsibilities.
Provide compliance guidance to Sales, Account Management, and Operations related to new services, scope expansions, and client-specific regulatory frameworks.
Maintain strong working knowledge of payer guidelines (Medicare Advantage, CMS, Medicaid, Commercial plans).
Promote a culture of compliance and ethical behavior throughout the organization.
Develop and deploy compliance training for all staff and support functions on regulatory topics and client-specific requirements.
Communicate updates proactively to ensure the organization stays ahead of regulatory and payer changes.
Model and reinforce a culture of transparency, accountability, and ethical service delivery across all global sites.
Hire, onboard, train and manage global Compliance team resources.