Vice President, Compliance-Centerwell Care Delivery Greater New York City, NY Area + 9 more

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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

Lead the compliance program for CenterWell care delivery operations, working with the Chief Compliance Officer to establish vision, strategy, priorities, and measures of effectiveness aligned with enterprise objectives and regulatory expectations.

Create, own, and execute a risk-based compliance strategy that addresses the current portfolio, anticipated growth, changing reimbursement models, emerging technologies, and evolving enforcement priorities.

Serve as the principal compliance advisor to CenterWell care delivery executive leadership and provide constructive challenge on strategic, clinical, operational, financial, and growth decisions.

Ensure effective implementation of the Company’s Compliance Program across supported businesses, including policies and procedures, governance, training, reporting mechanisms, enforcement, risk assessment, monitoring and auditing, investigations, corrective action, and effectiveness evaluation.

Evaluate and continuously improve program effectiveness using applicable Office of Inspector General guidance, government program expectations, regulatory outcomes, industry developments, and internal performance data.

Authority, Independence, and Reporting

Exercise independent judgment and authority, with direct and unrestricted access to the Chief Compliance Officer, relevant executive leaders, and applicable compliance and governing committees.

Chair the CenterWell Compliance Committee, establish a risk-focused agenda, ensure appropriate executive participation, and oversee timely escalation and resolution of significant compliance matters.

Provide regular, candid, and transparent reporting to executive leadership, the Corporate Compliance Committee, and the Board or its committees, as appropriate.

Compliance Risk Management, Monitoring, and Auditing

Lead enterprise-aligned compliance risk assessments for the CenterWell care delivery portfolio and maintain a current, documented inventory of legal, regulatory, contractual, and operational compliance risks.

Identify, assess, prioritize, and communicate risks arising within care delivery operations and at the intersection of provider, payer, delegated, and affiliated activities.

Develop and oversee risk-based compliance monitoring, auditing, data analytics, and control-testing activities.

Oversee timely remediation of compliance issues, control deficiencies, audit findings, and regulatory observations; approve or challenge corrective action plans and validate sustainable closure.

Establish effective matrixed oversight with Insurance Compliance for requirements that span payer and provider operations, including delegated Medicare Advantage functions, utilization management, risk adjustment, encounters and claims, quality obligations, member and patient protections.

Partner with Operational Risk Management, Legal, Enterprise Risk Management, Quality, and Internal Audit to coordinate risk coverage, leverage shared insights, clarify roles, and reduce gaps or duplication.

Investigations and Regulatory Response

Oversee the intake, triage, investigation, escalation, and resolution of significant care delivery compliance matters, including allegations involving fraud, waste, and abuse; documentation and billing; patient rights; professional conduct; and regulatory noncompliance.

Coordinate with Legal and other accountable functions on privilege, potential overpayments and refunds, government-program implications, self-disclosure or reporting obligations, and disciplinary or contractual action.

Provide compliance leadership for government inquiries, examinations, surveys, audits, subpoenas, corrective action plans, and other regulatory engagements affecting supported businesses.

Acquisition and Growth Support

Provide compliance leadership for acquisitions, affiliations, joint ventures, management services arrangements, and new care delivery models.

Participate in regulatory due diligence, identify material pre-close and post-close risks, and establish risk-based compliance integration plans for acquired or newly formed operations.

Advise on new clinical services, market expansions, technology implementations, digital health, artificial intelligence, and material workflow changes before implementation.

Evaluate whether growth initiatives create new licensing, enrollment, reimbursement, referral, privacy, patient-safety, accreditation, or government-program obligations.

Compliance Advising, Education, and Culture

Advise senior and operational leaders on regulatory expectations, risk mitigation, investigations, government inquiries, and practical solutions that support business objectives without assuming operational responsibility.

Develop role-based compliance education and communication strategies tailored to executive, clinical, provider, coding, revenue-cycle, operational, and compliance audiences.

Promote a culture in which issues are identified early, concerns can be raised without retaliation, leaders accept accountability, and compliance is integrated into business decision-making.

Partner with clinical, quality, and patient-safety leadership to identify and escalate systemic risks that may create compliance, reimbursement, reporting, accreditation, or enforcement exposure while maintaining appropriate separation between compliance oversight and operational ownership.

Team, Talent, and Resource Leadership

Design and lead an appropriately structured, risk-aligned compliance organization with clear accountability across supported businesses and risk domains.

Recruit, develop, mentor, and retain senior compliance leaders and specialized subject-matter experts; establish succession and leadership-development plans.

Set clear priorities, performance expectations, decision rights, service standards, and accountability for the compliance team.

Establish resource, budget, technology, data, and external-advisor priorities based on the compliance risk profile and business strategy.

Promote consistent enterprise methodologies while preserving the specialized expertise required for primary care, ACO, home health, post-acute, delegated, and ancillary operations.

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.

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