Director of Compliance

Job Description

Job Description

Director of Compliance

POSITION SUMMARY

The Director of Compliance is responsible for overseeing and managing all aspects of Solis Health Plans’ Compliance Program to ensure adherence to Center for Medicare & Medicaid Services (CMS) regulations, state and federal laws, and internal policies and procedures. This executive-level leader plays a critical role in promoting a strong culture of compliance and ethical behavior across the organization, ensuring that Solis Health Plans’ operations meet or exceed all applicable regulatory and accreditation standards for Medicare Advantage and Part D programs. Serves as the primary liaison with regulatory agencies.

DUTIES AND RESPONSIBILITIES

• Develop, implement, and oversee the organization’s Compliance and Risk Management Program, ensuring alignment with CMS, HIPAA, and state regulations.
• Lead regulatory audits, risk assessments, and corrective action plans, maintaining documentation and timely reporting to CMS and internal governance committees.
• Oversee delegation oversight, ensuring compliance of all First-Tier, Downstream, and Related Entities (FDRs).
• Manage compliance performance metrics, reporting, and audit readiness, including CMS Program Audits (CPE, ODAG, CDAG, Formulary Administration, and Transition Monitoring).
• Coordinate and approve regulatory submissions, marketing materials, and communications requiring CMS or AHCA approval.
• Direct the creation and delivery of annual compliance and privacy training programs for all employees, contractors, and First-Tier, Downstream and Related Entities (FDRs) ensuring employees and partners understand obligations under federal and state programs.
• Report regularly to the CEO, Board of Directors, and Compliance Committee on compliance status, risks, and mitigation efforts. Ensure timely and accurate submission of required CMS reports, attestations, and certifications.
• Oversee monitoring of fraud, waste, and abuse (FWA) programs, including SIU coordination, OIG / GSA exclusion checks, and internal investigations.
• Lead and manage the organization’s response to CMS audits, including Comprehensive Program Audit (CPE, ODAG, CDAG, Formulary Administration and Transition Monitoring)

SUPERVISORY RESPONSIBILITY

Yes

QUALIFICATIONS & EDUCATION