Vice President, Health Plan Compliance

Independent Living Systems

2d

About The Position

The Vice President of Health Plan Compliance plays a critical leadership role in ensuring that the organization adheres to all applicable federal, state, and local regulations governing health plan operations. This position is responsible for developing, implementing, and maintaining comprehensive compliance programs that mitigate risk and promote ethical business practices across the health plan. The role requires close collaboration with executive leadership, legal counsel, and operational teams to monitor regulatory changes and adapt policies accordingly. The Vice President will lead compliance audits, investigations, and training initiatives to foster a culture of compliance and accountability. Ultimately, this role ensures the organization maintains its reputation, avoids penalties, and delivers high-quality, compliant health care services to its members.

Requirements

• Bachelor’s degree in Health Administration, Business, Law, or a related field.
• At least 10 years of experience in health plan compliance or regulatory affairs within the health care services industry.
• Demonstrated knowledge of federal and state health care regulations including HIPAA, CMS guidelines, and the Affordable Care Act.
• Proven experience leading compliance programs and managing teams.
• Strong understanding of health plan operations and risk management principles.
• Relevant experience may substitute for the educational requirement on a year-for-year basis.

Nice To Haves

• Master’s degree in Health Administration, Public Health, Law, or a related discipline.
• Certification in health care compliance such as Certified in Healthcare Compliance (CHC) or equivalent.
• Experience working with Medicare and Medicaid health plans.
• Proven track record of successfully managing regulatory audits and investigations.

Responsibilities

• Develop, implement, and oversee the health plan’s compliance program to ensure adherence to all relevant laws, regulations, and accreditation standards.
• Monitor regulatory developments and assess their impact on organizational policies and procedures, providing timely guidance to leadership and staff.
• Collaborate with cross-functional teams including legal, operations, and quality assurance to integrate compliance requirements into business processes.
• Stay up-to-date on changes to laws, regulations, and policies related to health plan compliance, and ensure that the organization is in compliance with these changes.
• Lead and manage a team of compliance professionals.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive