Regulatory Compliance Lead

LIFE Pittsburgh•Green Tree, PA

8d•$50,000 - $70,000

About The Position

Under the direction of the Director of Quality and Compliance, the Regulatory Compliance Lead leads and maintains LIFE Pittsburgh’s Compliance Program. The role translates external requirements and internal standards into organizational expectations; identifies and prioritizes compliance vulnerabilities; verifies compliance; investigates concerns; and oversees corrective-action follow-through. The Lead provides compliance guidance, independent review, monitoring, and escalation across the organization. Operational leaders remain accountable for compliant service delivery, controls, documentation, and corrective actions in their areas. The Lead works with those leaders to clarify ownership and verify that corrections achieve intended results. The role collaborates with Quality, clinical and operational leadership, Human Resources, Training and Education, Health Information, Technology, Finance, Health Plan Administration, and contractors. Regulatory communications and external submissions are coordinated through the Director and approved organizational channels. Privacy, information security, policy governance, and organization-wide risk work are performed with designated owners. The position maintains the compliance framework and annual work plan; tracks and interprets applicable requirements; assesses and prioritizes vulnerabilities; conducts and coordinates audits and monitoring; investigates suspected or confirmed noncompliance; and coordinates corrective actions through implementation and effectiveness testing. It also promotes reporting and compliance education, supports regulatory readiness and reporting, maintains compliance records, evaluates program effectiveness, and contributes compliance expertise to quality assurance and performance improvement activities. Work includes computer use, document review, meetings, and interviews, with travel to LIFE Pittsburgh sites and vendor locations as needed. A valid driver’s license, automobile insurance, and access to a vehicle are required for work-related travel. Essential work includes sustained review of electronic and written information, keyboard use, effective communication, and movement within and between work locations. Essential functions may be performed with or without reasonable accommodation.

Requirements

Bachelor’s degree in a related field.
A minimum of three years of demonstrated experience managing and interpreting regulations, preferably in healthcare.
A minimum of three years of demonstrated experience leading a corporate compliance program, including Medicare Part D compliance requirements.
Ability to research and interpret healthcare requirements and translate them into clear policies, controls, practical guidance, and evidence expectations.
Strong auditing, investigation, root cause analysis, data analysis, and process mapping skills; ability to separate facts from assumptions and assess evidence reliability.
Sound judgment, integrity, discretion, and objective problem-solving; ability to maintain confidentiality and handle sensitive concerns fairly.
Clear written and verbal communication skills, including educating, facilitating meetings, documenting findings, and giving leaders concise information about risk and progress.
Ability to work independently, manage competing priorities and deadlines, collaborate across departments, and pursue follow-up through verified resolution.
Proficiency with office applications and electronic tools for records, reporting, audit tracking, and compliance analysis.
Valid driver’s license, automobile insurance, and access to a vehicle for work-related travel.

Nice To Haves

PACE experience.
Healthcare compliance certification.

Responsibilities

Maintain the compliance framework, including standards of conduct, policies, reporting channels, oversight processes, and an annual work plan; coordinate annual review and approval through leadership and Board processes.
Lead Compliance Committee activities, including agendas, documented decisions, issue tracking, follow-up, and reports; support leadership and Board oversight with information about material risks, unresolved issues, and program effectiveness.
Track and interpret applicable federal, Pennsylvania, and local requirements, CMS PACE requirements, Medicare and Medicaid obligations, applicable Part D requirements, HIPAA and other privacy and security obligations, workplace safety requirements, program agreements, contractual obligations, and organizational standards.
Translate requirements into practical expectations with identified owners, evidence needs, and implementation timelines; distinguish binding requirements from guidance and internal standards, and seek clarification when interpretation is uncertain.
Maintain a documented assessment of compliance vulnerabilities using regulatory changes, audit findings, incidents, complaints, grievances, contractor concerns, and operating data; prioritize risks and escalate material or emerging risks.
Develop a risk-based compliance work plan with defined review activities, responsibilities, and timeframes, and contribute compliance information to organization-wide risk management.
Conduct and coordinate internal audits and monitoring; define scope, review criteria, sampling methods, evidence sources, and findings; retain supporting records.
Review policies, procedures, records, service-delivery evidence, and relevant data for consistency with requirements; evaluate contractor compliance with contract and operational owners.
Identify cross-department patterns, communicate results, distinguish internal testing from external regulatory readiness, and recommend evidence-based improvements.
Receive, triage, and review suspected or confirmed noncompliance, including hotline reports and potential fraud, waste, abuse, privacy concerns, or operational failures; coordinate investigations with appropriate specialists and leaders.
Gather objective facts, determine scope and impact, preserve evidence, document conclusions, and identify the earliest meaningful breakdown in requirements, ownership, workflow, capacity, training, information, or controls.
Coordinate immediate protective action and corrective action plans with responsible operational owners, with clear actions, accountable owners, due dates, monitoring tasks, and measures of success.
Track corrective-action implementation, test effectiveness, verify sustained improvement before recommending closure, and escalate overdue actions, persistent risk, or inadequate results through approved channels.
Maintain accessible employee and contractor reporting mechanisms, including confidential and anonymous options consistent with organizational processes; reinforce good-faith reporting and nonretaliation and protect information within appropriate access limits.
Partner with Training and Education and subject matter owners to develop compliance education, monitor completion, and evaluate understanding where appropriate.
Provide timely guidance and communicate lessons from findings so employees and leaders understand requirements and how to meet them in daily work.
Coordinate compliance readiness for surveys, audits, and external reviews; maintain organized evidence, track readiness gaps, and work with departments to demonstrate ongoing fulfillment of requirements.
Support accurate, timely regulatory responses and submissions as assigned; track reporting obligations, deadlines, supporting evidence, and follow-up through approved channels.
Coordinate Part D fraud, waste, and abuse reviews with Health Plan Administration and relevant vendors; support evaluation and authorized reporting of potential fraud to CMS or the appropriate program integrity contractor when required or appropriate.
Maintain compliance records, including requirement tracking, assessments, audits, investigations, Committee records, education evidence, regulatory submissions, and corrective-action verification, consistent with retention and confidentiality requirements.
Report measures such as work plan completion, unresolved findings, overdue corrective actions, repeat issues, and verified effectiveness; evaluate program effectiveness and recommend improvements.
Participate in quality assurance and performance improvement activities as assigned, contributing compliance expertise while preserving operational accountability for underlying work.