Vice President, Compliance-Centerwell Care Delivery
2 days ago
Fort Lauderdale
The Vice President, Compliance- Centerwell Care Delivery is a senior compliance executive responsible for leading the design, implementation, operation, and continuous improvement of the compliance program supporting CenterWell's care delivery businesses. The CenterWell care delivery portfolio includes senior-focused primary care, accountable care organization operations, home health, post-acute delegated clinical services, and other provider, ancillary, affiliated, or acquired healthcare operations assigned to the role. Reporting to the Chief Compliance Officer and serving as a member of the Compliance Leadership Team, the Vice President provides independent, risk-based compliance oversight and serves as the principal compliance advisor to CenterWell care delivery executive leadership. The role ensures that supported businesses maintain effective compliance programs aligned with applicable federal and state laws, government healthcare program requirements, accreditation and contractual obligations, Company policies, and recognized elements of an effective compliance program. The Vice President leads a team of roughly nine compliance professionals, chairs the CenterWell Compliance Committee, and provides transparent reporting regarding significant risks, investigations, regulatory matters, monitoring and audit results, corrective actions, and program effectiveness. The role works closely with Insurance Compliance, Legal, Internal Audit, Operational Risk Management, Enterprise Risk Management, Privacy, Quality, Government Affairs, Finance, and Human Resources to manage enterprise risks while preserving the independence of the compliance function. Key Role Responsibilities • Strategic Compliance Leadership, • Authority, Independence, and Reporting, • Compliance Risk Management, Monitoring, and Auditing, • Investigations and Regulatory Response, • Acquisition and Growth Support, • Compliance Advising, Education, and Culture, • Team, Talent, and Resource Leadership Regulatory and Risk Portfolio • Federal healthcare program participation, reimbursement, enrollment, and reporting requirements., • Federal and state fraud, waste, and abuse laws, including the False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, and beneficiary-inducement requirements., • Clinical documentation, coding, medical necessity, billing, claims, refunds, overpayments, cost reporting, and payment integrity., • Risk adjustment, value-based payment, ACO, Medicare Shared Savings Program, and incentive-based payment integrity., • Home health Conditions of Participation and Conditions of Payment, • Post-acute and delegated utilization management requirements., • Corporate practice of medicine, professional-entity governance, prescribing, scope of practice, supervision, and collaborative practice requirements., • Patient rights, nondiscrimination, accessibility, informed consent, patient choice, complaints, and continuity of care., • Quality of care, patient safety, adverse-event reporting, and accreditation or certification requirements., • Marketing, referral relationships, financial relationships, sales practices, and compensation arrangements., • Provider, practitioner, facility, and entity licensure; enrollment; credentialing; exclusions; sanctions; and accreditation., • Privacy, digital health, artificial intelligence, and medical-record integrity, in partnership with accountable enterprise functions., • Medicare Advantage, Medicare Part D, Medicare fee-for-service, Medicaid, and other federal and state program requirements applicable to or flowing through care delivery operations. Use Your Skills to Make an Impact Required Qualifications • 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. Preferred Qualifications • Advanced degree in law, healthcare administration, public health, business, accounting, finance, or a related field., • Recognized healthcare compliance certification, such as CHC, CHPC, CHC-F, CCEP, or a comparable credential., • Experience in an integrated healthcare organization combining payer and provider operations., • Experience with primary care, home health, ACO or MSSP operations, value-based care, or risk-bearing provider arrangements., • Experience supporting acquisitions, affiliations, joint ventures, and post-close compliance integration., • Experience overseeing multi-state provider licensure, enrollment, credentialing, accreditation, or regulatory survey activity., • Experience applying data analytics, technology, and scalable monitoring methods to compliance oversight. Additional information: 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 Scheduled Weekly Hours 40 About Us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.