Operational Risk Associate Jobs in Santa Clara, CA

Location: Palo Alto, California 94304

Work Arrangement: Hybrid

Employment Type: Full-Time

The Compliance Director will lead the development, integration, and ongoing management of CHC’s enterprise-wide compliance program. The Compliance Director will ensure CHC maintains rigorous standards for regulatory compliance and continuous quality improvement through regular audits, incident metrics, corrective action tracking, and staff training.

This role serves as CHC's designated Compliance Officer. To preserve the independence of the compliance function, the Compliance Director/Compliance Officer reports administratively to the CEO for day-to-day operations and has separate, direct, and unfettered reporting access to the Chair of the Board Audit Committee for compliance matters, investigations and any concerns involving executive leadership, consistent with OIG compliance program guidance. They follow the guidance listed in the “Compliance Officer Reporting Structure and Independence” policy.

In this position, the Compliance Director meets the expectations set by the CEO and Board associated with building an effective centralized Compliance function. Previous years of experience in scaling and maturing Compliance functions will be required. The role is hands‑on and requires excellent collaboration and communication skills to enhance structures, and align stakeholders. They will strengthen oversight, and embed compliance into daily operations across clinical, educational, privacy, billing, HR, cybersecurity, facilities, and governance functions.

• Design, implement, and maintain a centralized compliance program aligned with federal, state, and local laws and regulations, including OIG guidance, OSHA, HIPAA, 42 CFR Part 2, HITECH, CMS, Medi-Cal, Medicaid billing rules, child welfare laws, minor consent laws, and licensure and accreditation requirements
• Establish compliance governance, ownership, workflows, escalation paths, and accountability across all departments
• Partner with senior leadership and the Board to reinforce compliance expectations and maintain appropriate visibility
• Manage and lead the Compliance Committee, partnering with subject matter experts to apply best practices to incident reporting and compliance investigations
• Coordinate investigations and recommend corrective or disciplinary actions with leadership and HR through resolution
• Maintain anonymous compliance reporting mechanisms and document concerns or potential violations
• Ensure required external reporting, including breaches, abuse allegations, and licensing board issues
• Manage the compliance program budget and, with Board Audit/Compliance Committee support, retain outside counsel, auditors, or consultants as needed

• Prepare quarterly and annual compliance reports for executive leadership and the Board, including annual risk/work plan presentations and program effectiveness assessments
• Oversee and effectively manage the Compliance Committee comprised of multiple department leaders
• Maintain a direct line of communication with the Board Audit/Compliance Committee Chair, independent of the CEO and other executive leadership, for escalating compliance concerns, investigation findings, and matters involving senior leadership conduct
• Provide meaningful metrics on training, audits, incidents, policy status, investigations, corrective actions, and emerging risks

• Work closely with clinical services, schools, billing and coding, IT/EHR, HR, and external consultants to establish and maintain compliance best practices across all teams and processes
• Collaborate with external auditors, payers, licensing bodies, and legal counsel when necessary

• Perform other related duties as required and assigned.

• Lead development, review, approval, implementation, and version control for compliance-related policies and procedures
• Prioritize and finalize critical policies covering billing, Fraud/Waste/Abuse, Business Associate Agreements, FERPA, HIPAA, whistleblower and non-retaliation, conflict resolution, telehealth, cybersecurity, and incident reporting
• Ensure policies are consistently applied across departments and remain current, accessible, and aligned with operational workflows and clinical best practices

• Draft, review, and update policies related to compliance, privacy, security, telehealth, record retention, documentation, billing, and employee conduct.

  - Ensure policies are current, accessible, and aligned with operational workflows and clinical best practices.

• Assess clinical, school, and operational risk and collaborate with leadership to reduce liability and improve care quality
• Support quality assurance and performance improvement initiatives
• Monitor patient complaints, incidents, and documentation errors to identify system-level compliance gaps
• Support external audits and monitoring activities, including annual Medi-Cal and CDE audits
• Develop and execute annual internal audit plans for billing, documentation, credentialing, and clinical operations
• Track audit findings, remediation, and compliance trends
• Review outpatient mental health records for documentation compliance, including timely progress notes, treatment plan updates, and consent forms
• Investigate suspected noncompliance, fraud, waste, or abuse and develop corrective action plans

• Oversee vendor compliance activities, including Business Associate Agreements and other required compliance documentation
• Partner with legal, finance, IT, and operational leaders to ensure third-party risk is appropriately assessed and managed

• Identify needs and develop and deliver compliance training for senior leadership, schools, and clinical, administrative, and billing staff on topics including HIPAA, patient confidentiality, minor consent, mandated reporting, clinical documentation, billing, suspected violation reporting, non-retaliation, and Board compliance
• Conduct new employee compliance orientation and periodic refresher training
• Work with program leaders to track completion of required compliance trainings

• Establish compliance governance structure, including Board Audit Committee charter and reporting cadence
• Finalize and roll out priority policies (billing, Fraud/Waste/Abuse, whistleblower and non-retaliation, incident reporting)
• Launch organization-wide compliance training program, including new-hire orientation
• Deliver first comprehensive compliance report directly to the Board Compliance Committee

• Bachelor's degree in law, healthcare administration, public administration, business, compliance, or related field
• 10+ years of relevant compliance experience, preferably in healthcare, behavioral health, education, nonprofit, or similarly regulated environments
• Strong knowledge of healthcare compliance, HIPAA, FERPA, Fraud/Waste & Abuse, billing/coding compliance, privacy, incident reporting, and regulatory training requirements (Medi-Cal, state, federal, and local regulations)
• Previous experience serving as a designated compliance officer or leading an independent compliance function
• Demonstrated experience leading or helping build an independent compliance function, including investigations, auditing, risk assessment, corrective actions, Board reporting, and compliance committee administration
• Experience building or maturing a compliance program, ideally in an organization transitioning from decentralized to centralized compliance
• Demonstrated ability to work cross-functionally with clinical, school, HR, IT, finance, legal, and executive teams
• Experience reporting to senior leadership and/or a Board committee
• One or more compliance certifications preferred, such as CHC, CHPC, CHC-F, CCEP, or similar

• Certified in Healthcare Compliance (CHC) – Health Care Compliance Association
• Certified Professional in Healthcare Quality (CPHQ)
• Certified Compliance & Ethics Professional (CCEP)
• Master's Degree in related fields
• JD, healthcare legal/compliance background, behavioral health clinical background, school district/education compliance background, or healthcare operations leadership experience strongly preferred when paired with substantial compliance program responsibility

• Stays up to date with the latest regulatory changes affecting education and behavioral health compliance
• Advanced knowledge of proper protocols for conducting investigations, auditing, monitoring, and applying corrective actions
• In-depth knowledge of HIPAA, 42 CFR Part 2, Medicaid rules, and behavioral health documentation practices
• Strong working knowledge of pediatric mental health compliance issues, including minor consent and mandated reporting
• Excellent organizational, time management, and project coordination skills
• Outstanding written and verbal communication skills for drafting policies, reports, and delivering training
• Ability to maintain confidentiality and manage sensitive situations with discretion and professionalism
• Proficiency in Microsoft Office Suite and electronic health record systems
• Capacity to think critically, act independently, and exercise sound judgment under pressure

• Ability to occasionally lift, move, and set up stacks of documents such as training binders and other training materials, laptops, projectors, flip charts, and other materials required for meetings and presentations
• Ability to work for extended periods of time at a computer
• Required to have regularly scheduled site visits to all office locations and reliable transportation to visit sites as needed

This position requires extensive interpersonal interaction with peers and outside contacts, including clinical staff, administrative teams, Board members, external auditors, and regulatory agencies.