Sr. Director, Compliance and Privacy

JOB SUMMARY:

Under the direction of the Health Plan Compliance Officer, the Senior Director of Compliance & Privacy provides leadership and oversight of the organization's compliance and privacy programs. This position is responsible for developing, implementing, and maintaining an effective compliance framework that promotes adherence to applicable federal and state laws, HIPAA regulations, and organizational policies. The Senior Director of Compliance & Privacy fosters a culture of ethics, accountability, and regulatory excellence while also serving as the organization's HIPAA Privacy Officer.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

• Lead, develop, and manage the organization's compliance program in alignment with federal and state regulations, and industry best practices.
• Supervise and mentor compliance staff, building a high-performing, collaborative team environment.
• Design and oversee internal auditing and monitoring programs, conduct enterprise-wide risk assessments, maintain the annual compliance auditing and monitoring work plan.
• Identify vulnerabilities and implement mitigation strategies.
• Oversee incident reporting and compliance investigations, ensuring timely resolution and appropriate corrective action.
• Oversee and coordinate external audits, reviews, site visits, and inquiries conducted by regulatory agencies, and other oversight entities, lead ongoing readiness activities to ensure organizational preparedness, and oversee corrective action plans resulting from internal and external audit findings.
• Oversee compliance committee activities and present regular updates to leadership and stakeholders.
• Develop, implement, and maintain compliance policies, procedures, and standards of conduct.
• Design and deliver compliance training and promote awareness of compliance standards, regulatory requirements and ethical behavior across the organization.
• Monitor changes in applicable federal, state, local, and grant-related regulatory requirements and evaluate operational impacts to ensure ongoing compliance, including but not limited to Medicare Advantage and Prescription Drug Program requirements and regulations, 340B Drug Pricing Program compliance requirements, HIPAA Privacy, Security, and Breach Notification Rules, Medicare program requirements, Fraud, Waste, and Abuse laws and regulations, Office of Inspector General (OIG) compliance guidance, applicable state health maintenance organization regulations and reporting requirements, clinical documentation, quality, and patient safety standards.
• Serve as HIPAA Privacy Officer and collaborate with the designated HIPAA Security Officer and Legal division staff to ensure coordinated oversight of privacy and security compliance activities.
• Oversee privacy incident responses and investigations, breach notification and reporting requirements, annual HIPAA risk assessments and mitigation activities.
• Performs other duties as assigned.

JOB REQUIREMENTS:

• Strong project management and organizational skills with the ability to manage multiple priorities and deadlines.
• Excellent written, verbal, and presentation skills.
• Ability to interpret and communicate complex regulatory requirements in a clear and practical manner.
• Strong interpersonal skills and ability to build collaborative relationships across all organizational levels.
• Proficiency with Microsoft Office applications, compliance management systems, incident reporting platforms.
• Ability to analyze data, prepare reports, and monitor compliance metrics and key performance indicators.

REQUIRED QUALIFICATIONS:

• Bachelor's degree in Healthcare Administration, Public Health, Business Administration, Health Information Management, Law, or a related field required.
• Minimum of three (3) years of progressively responsible experience in healthcare compliance, privacy, risk management, auditing, legal/regulatory affairs, or related healthcare operations.
• Minimum of three (3) years of leadership or management experience overseeing compliance and/or privacy programs.
• Relevant professional certification, such as Certified in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional (CCEP), Certified in Healthcare Privacy Compliance.