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Position Overview:

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Senior Director of Product Compliance, reporting to the Vice President of Compliance, provides strategic leadership and oversight for MetroPlusHealth's Product Compliance and External Audit functions across all lines of business, including Medicaid, HIV SNP, HARP, CHP, Essential Plan, QHP, Large Group, Medicare, MAP, MLTC, and other integrated products.

This role is responsible for leading the State Product Compliance, Federal and Integrated Product Compliance, and External Audit teams, ensuring organizational readiness for regulatory oversight, driving enterprise-wide implementation of regulatory requirements, and promoting a culture of proactive compliance. The Senior Director serves as a key advisor to executive leadership on regulatory risk, corrective action strategies, audit readiness, and compliance program effectiveness.

The position is responsible for developing compliance strategies that align with organizational priorities, overseeing regulatory implementation efforts, supporting risk assessment activities, and ensuring consistent monitoring and reporting of compliance performance across the organization.

Scope of Role & Responsibilities

• Provides strategic leadership and oversight for the State Product Compliance, Federal and Integrated Product Compliance, and External Audit teams.
• Responsible for the day-to-day operations, performance, and resource management of Product Compliance and External Audit functions.
• Establishes departmental goals, priorities, and performance metrics aligned with organizational objectives and the Compliance Department's strategic plan.
• Provides leadership, coaching, mentorship, and professional development to Directors, managers, and compliance staff.
• Contributes to the annual compliance risk assessment, collaborating with Compliance and business stakeholders to identify, evaluate, and prioritize regulatory and operational compliance risks.
• Supports the development, execution, and presentation of the Annual Compliance Work Plan and oversees completion of auditing and monitoring activities assigned to Product Compliance.
• Develops, implements, and revises policies, procedures, and departmental standards to ensure compliance with applicable federal and state regulatory requirements.
• Provides regulatory implementation oversight by ensuring applicable regulatory requirements are effectively operationalized by internal business units, delegated entities, and external vendors.
• Evaluates emerging regulatory risks and provides recommendations to executive leadership regarding compliance preparedness, mitigation strategies, and operational impacts.
• Ensures open lines of communication, both internally and externally, so that reports of potential non-compliance are appropriately received, investigated, escalated, and resolved.
• Oversees the identification and resolution of compliance issues and provides guidance to business areas regarding root cause analysis, corrective action development, monitoring methodologies, and regulatory impact assessments.
• Oversees preparation of regulatory disclosures, self-reports, and other compliance-related submissions to federal and state regulatory agencies, as necessary.
• Partners with business areas to develop and enhance monitoring activities and key performance indicators designed to assess ongoing compliance with regulatory requirements.
• Provides oversight of external regulatory examinations, CMS program audits, NYS Department of Health reviews, independent compliance program evaluations, and other compliance-related assessments.
• Oversees organizational audit readiness activities and manages external examinations, regulatory audits, independent assessments, and corrective action governance.
• Monitors progress of corrective actions resulting from audits, investigations, assessments, and regulatory reviews to ensure timely and sustainable remediation.
• Prepares and presents reports, dashboards, risk analyses, and committee materials for senior leadership, the Vendor Delegation Oversight Subcommittee, Internal Compliance Committee, and the Audit and Compliance Committee of the Board of Directors.
• Serves as a voting member of the Vendor Delegation Oversight Subcommittee, providing compliance advisement and ensuring delegate-related compliance issues, trends, and risks are appropriately evaluated and reported.
• Collaborates with business leaders across the organization to develop and implement effective compliance solutions, regulatory strategies, and process improvements.
• Represents the Compliance Department in interactions with regulators and auditors.
• Other duties as assigned or requested.

Required Education, Training & Professional Experience  

• Bachelor's Degree required. Master's Degree in Healthcare Administration, Public Health, Business Administration, Law, or related field preferred.
• Minimum ten (10) years of progressive experience in healthcare compliance, healthcare administration, managed care operations, regulatory affairs, auditing, or related healthcare functions.
• Minimum five (5) years of leadership experience managing managers, directors, or multidisciplinary teams responsible for compliance, regulatory, auditing, or operational functions.
• Demonstrated expertise in Medicare Advantage, Medicaid Managed Care, MAP, MLTC, Integrated Care, and New York State Department of Health regulatory requirements.
• Demonstrated experience leading regulatory audits, external reviews, compliance investigations, corrective action planning, regulatory implementation initiatives, and delegation oversight activities.
• Experience presenting compliance matters, audit results, risk assessments, and corrective action plans to executive leadership and governing committees.
• Strong working knowledge of CMS, NYS Department of Health, OIG compliance guidance, delegation oversight requirements, and industry best practices.
• Advanced project management, organizational, and process improvement skills with the ability to manage multiple priorities and deadlines.
• Ability to utilize software applications and reporting tools to produce required documentation, analyses, and presentations.

Licensure and/or Certification Preferred

• Certified in Healthcare Compliance (CHC)
• Certified Compliance & Ethics Professional (CCEP)

Professional Competencies

• Integrity and Trust
• Customer Focus
• Strategic Thinking
• Leadership and Team Development
• Functional/Technical Expertise
• Outstanding interpersonal and relationship management skills with the ability to influence stakeholders at all organizational levels.
• Strong analytical, problem-solving, decision-making, and organizational skills.
• Demonstrated ability to assess risk, analyze complex regulatory requirements, and develop practical compliance solutions.
• Exceptional written, verbal, presentation, and communication skills.
• Ability to effectively collaborate with executive leadership, regulators, auditors, accreditation organizations, business stakeholders, and external partners.
• Demonstrated ability to manage change, build high-performing teams, foster accountability, and drive organizational results.
• Exceptional attention to detail and commitment to operational excellence.

This is a remote position but occasional in-person attendance may be required at the employee's expense - approximately 4 to 6 times a year. 

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