Director Compliance

Company: AmeriHealth Caritas
Location: Washington
Posted on: May 20, 2025

Job Description:

In order to be considered for this position, must CURRENTLY reside in the D.C. / DMV region. This position incorporates a hybrid work schedule working 1 day remotely and 4 days a week at our AmeriHealth DC office located at 1201 Maine Avenue, S.W., Suite 1000, 10th Floor, Washington, DC 20024.Responsibilities:The Director, Compliance, will be responsible for the strategic direction and leadership in developing and implementing policy, process, and control activities aligned with the seven elements of a Compliance Program as defined by 42 CFR 439.608(b). This role oversees all operating divisions and subsidiaries across compliance and regulatory functions, including managing staff responsible for state regulatory and contractual monitoring. The person in this role also serves as the AmeriHealth DC Market Chief Compliance Officer, Privacy/Security Officer, and Program Integrity Director.Essential Functions

• Policy and Procedure Development
• Responsible for developing, implementing, reviewing, and revising policies, procedures, and practices to ensure compliance with contracts, and state and federal laws and regulations.Compliance Oversight

• Accountable for creating, implementing, and monitoring the annual compliance plan and work plan activities for the Line of Business (LOB).
• Lead the creation and execution of the LOB Compliance Committee and its charter.
• Document, report, and escalate compliance issues and risks to senior leadership, the Regulatory Compliance Committee, Board of Directors, and other relevant committees.
• Provide strategic guidance for compliance policies, processes, and controls.
• Collaborate with LOB leadership on contract amendments, communication of contract changes, and monitoring their implementation.
• Oversee compliance with fraud, waste, and abuse activities in collaboration with the Program Integrity department.
• Coordinate with the Privacy department to oversee privacy incident reporting and management.
• Represent the organization in state and federal regulatory meetings as required.Education, Training, and Requirements
  • Develop, implement, and monitor compliance training, education, and communication programs.Reporting, Investigating, Monitoring, and Auditing
    • Oversee the implementation of regulatory changes and monitor compliance with performance metrics and requirements.
    • Investigate potential Code of Conduct violations and other non-compliance issues reported through enterprise mechanisms.
    • Design compliance testing methodologies and conduct ad-hoc reviews to evaluate operational processes and controls.
    • Provide technical assistance and conduct compliance research as needed.Enforcement and Disciplinary Actions
      • Partner with LOB and corporate teams to enforce disciplinary standards and accountability.Corrective Actions
        • Identify process gaps and deficiencies, and implement corrective actions with root cause analysis.
        • Manage remediation of regulatory correction actions and report non-compliance issues to authorities promptly.Education/Experience:
          • Bachelor's Degree required; equivalent education acceptable.
          • Minimum of 5 years experience in managed health care, with a focus on compliance oversight.Other Skills:
            • Strong knowledge of AmeriHealth Caritas, its affiliates, and the managed care industry.
            • Understanding of compliance strategies, controls, and reporting.
            • Self-motivated with project management skills.
            • Proficiency in Microsoft Office and SharePoint.
            • Excellent facilitation, collaboration, and teamwork skills to build cross-functional partnerships.
            • Strong problem-solving, critical thinking, and analytical skills.
            • Organizational skills with good judgment and ability to resolve ambiguities.
            • Ability to act independently with minimal supervision and take initiative.
            • Knowledge of process development and management, with a mindset for continuous improvement.
            • Ability to interpret contract and regulatory language; prior experience is a plus.
            • Effective program and project management skills.Our mission is to develop the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people access care, stay healthy, and build strong communities. Join us to make a meaningful difference in millions of lives through our comprehensive healthcare solutions. Learn more at .Diversity, Equity, and InclusionWe foster a workplace where everyone feels valued, supported, and free to be themselves. Our commitment to equity ensures all associates have the opportunity to thrive. We act with integrity and respect, stand against injustice, and promote inclusivity, making our company more vibrant, innovative, and capable of serving diverse communities.We prioritize our associates' well-being so they can focus on member health.Our BenefitsFlexible work options including remote and hybrid schedules, competitive pay, paid holidays and volunteer days, health coverage from Day 1, 401(k), tuition reimbursement, and more.
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Keywords: AmeriHealth Caritas, Harrisburg , Director Compliance, Executive , Washington, Pennsylvania