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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in healthcare compliance, risk management, and regulatory oversight, with a strong focus on leading compliance programs and advising executive leadership. Proven ability to develop and implement risk-based strategies, conduct compliance assessments, and foster a culture of accountability and early issue identification.
Highest-signal resume keywords
Healthcare Compliance LeadershipRisk Assessment and ManagementRegulatory Compliance ExpertiseExecutive Advisory and CommunicationTeam Development and Mentorship
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Compliance Program DevelopmentRisk-Based Compliance StrategyMonitoring and AuditingInvestigations and Corrective ActionsData Analytics for ComplianceRegulatory Response ManagementProvider Billing and Coding KnowledgeFraud and Abuse ComplianceHealthcare Reimbursement ModelsClinical Documentation Standards
Soft Skills
Analytical SkillsCommunication SkillsRelationship-BuildingExecutive PresenceIndependent Judgment
Certifications & Qualifications
CHCCHPCCHC-FCCEP
Industry Keywords
Healthcare AdministrationRisk-Bearing Provider ArrangementsValue-Based CareIntegrated Healthcare OrganizationMulti-State Provider Licensure
About the role
Key responsibilities & impact- Lead the compliance program for CenterWell care delivery operations and establish its vision, strategy, priorities, and effectiveness measures
- Create, own, and execute a risk-based compliance strategy addressing the care delivery portfolio, growth, reimbursement models, technologies, and enforcement priorities
- Serve as principal compliance advisor to CenterWell care delivery executive leadership and provide constructive challenge on strategic, clinical, operational, financial, and growth decisions
- Ensure implementation of policies, procedures, governance, training, reporting, enforcement, risk assessment, monitoring, auditing, investigations, corrective action, and effectiveness evaluation
- Exercise independent judgment and maintain direct access to the Chief Compliance Officer, executive leaders, and compliance and governing committees
- Chair the CenterWell Compliance Committee and oversee escalation and resolution of significant compliance matters
- Report significant risks, investigations, regulatory matters, monitoring and audit results, corrective actions, and program effectiveness to executive leadership, committees, and the Board
- Lead compliance risk assessments and maintain an inventory of legal, regulatory, contractual, and operational compliance risks
- Develop and oversee risk-based monitoring, auditing, data analytics, and control-testing activities
- Oversee remediation of compliance issues, control deficiencies, audit findings, and regulatory observations
- Coordinate matrixed oversight with Insurance Compliance and partner with Operational Risk Management, Legal, Enterprise Risk Management, Quality, and Internal Audit
- Oversee intake, triage, investigation, escalation, and resolution of significant care delivery compliance matters
- Coordinate on privilege, overpayments and refunds, government-program implications, self-disclosure, reporting obligations, and disciplinary or contractual action
- Lead compliance responses to government inquiries, examinations, surveys, audits, subpoenas, corrective action plans, and regulatory engagements
- Provide compliance leadership for acquisitions, affiliations, joint ventures, management services arrangements, and new care delivery models
- Participate in regulatory due diligence and establish compliance integration plans for acquired or newly formed operations
- Advise on new clinical services, market expansions, technology implementations, digital health, artificial intelligence, and workflow changes
- Advise senior and operational leaders on regulatory expectations, risk mitigation, investigations, inquiries, and practical solutions
- Develop role-based compliance education and communication strategies
- Promote a culture of early issue identification, non-retaliation, accountability, and compliance-integrated decision-making
- Design and lead a risk-aligned compliance organization
- Recruit, develop, mentor, and retain senior compliance leaders and subject-matter experts
- Establish succession plans, priorities, performance expectations, decision rights, service standards, accountability, and resource priorities
Requirements
What you’ll need- Bachelor’s degree in business, healthcare administration, public health, law, accounting, finance, or a related field
- 12 years plus of progressively responsible experience in healthcare compliance, legal, risk management, audit, or a related discipline, including substantial experience leading provider or care delivery compliance programs
- Demonstrated knowledge of government healthcare program reimbursement, provider billing and coding, clinical documentation, medical necessity, and federal and state fraud-and-abuse requirements
- 8 yrs plus of experience directing compliance risk assessments, monitoring and auditing, investigations, corrective actions, and regulatory responses
- Significant experience advising executive leaders and presenting complex or sensitive matters to executive committees, compliance committees, or governing bodies
- Leadership experience managing leaders and developing high-performing, multidisciplinary teams in a complex healthcare organization
- Demonstrated ability to operate through matrixed structures, influence senior stakeholders, exercise sound independent judgment, and translate complex requirements into practical guidance
- Exceptional analytical, communication, executive presence, and relationship-building skills
- Must reside or be willing to relocate to Louisville, KY, Tampa or Fort Lauderdale FL, Chicago IL, Boston MA, Arlington VA/DC, Dallas TX, Nashville TN, or New York, NY
- Preferred: advanced degree in law, healthcare administration, public health, business, accounting, finance, or a related field
- Preferred: recognized healthcare compliance certification, such as CHC, CHPC, CHC-F, CCEP, or a comparable credential
- Preferred: experience in an integrated healthcare organization combining payer and provider operations
- Preferred: experience with primary care, home health, ACO or MSSP operations, value-based care, or risk-bearing provider arrangements
- Preferred: experience supporting acquisitions, affiliations, joint ventures, and post-close compliance integration
- Preferred: experience overseeing multi-state provider licensure, enrollment, credentialing, accreditation, or regulatory survey activity
- Preferred: experience applying data analytics, technology, and scalable monitoring methods to compliance oversight
Benefits
Comp & perks- Full-time employment
- 40 scheduled weekly hours