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This is a full-time role operating from central or eastern regions of United States during standard business hours Monday - Friday (from your home office remotely) with travel in the United States for company meetings (this is not a flexible schedule opportunity). This role handles sensitive information; work must be performed in a private and secure setting (with a door) requiring reliable internet and phone connectivity.  This role does not offer immigration visa sponsorship. 

This role offers annual salary range of $200,000. We offer an excellent benefits package including 15 days of vacation, 7 paid holidays, and 5 sick days annually, multiple medical and vision insurance plans, which begin day one (no waiting period), employer-paid life insurance, 401(k) with a company match, $1,700 annual professional development reimbursement, $100 monthly teleworker stipend and more.

The Vice President of Compliance will lead the development, implementation, and oversight of a robust compliance program for the Integrated Continuum LTC ACO, a physician-led organization participating in the CMS Long-term Enhanced ACO Design (LEAD) Model (2027–2036). This role ensures full regulatory compliance with CMS Innovation Center requirements, Medicare Shared Savings Program principles, HIPAA, fraud and abuse laws, and all applicable federal and state regulations while supporting the ACO’s mission to deliver high-quality, coordinated care for long-term care (LTC), assisted living, dual-eligible, complex, and post-acute populations.

The position is critical to protecting the ACO’s ability to generate and retain shared savings, maintain accurate beneficiary attribution (including Voluntary Alignment), meet quality and financial benchmarks, and scale technology-enabled interventions such as Medrina Connect, SNF Command Center operations, real-time monitoring, and night/weekend telemedicine.

Essential Duties and Responsibilities (below are typical responsibilities and not an exhaustive list of all duties, other duties may be assigned as needed).

LEAD Model & ACO Regulatory Compliance

• Establish and maintain a comprehensive compliance program aligned with LEAD Model requirements, Primary Care Capitation / Total Care Capitation, concurrent risk adjustment for high-needs populations, quality withhold and earn-back mechanics, and CMS-Administered Risk Arrangements (CARA).
• Ensure accurate beneficiary alignment processes, including claims-based alignment and Signed Voluntary Alignment (SVA), while maintaining strict compliance with CMS marketing, beneficiary engagement, and anti-steering rules.
• Oversee compliance with LEAD quality measurement strategy (claims-based measures, patient experience/CAHPS, and phased-in eCQMs/dQMs), data submission requirements, and audit readiness.

Privacy, Security & Data Governance

• Lead HIPAA Privacy and Security compliance, including policies for PHI handling across Medrina Connect, facility EMRs, HIEs, FastPAC, and care coordination platforms.
• Oversee business associate agreements, data use agreements with CMS, and secure data exchange practices required for attribution, quality reporting, and shared savings calculations.
• Implement and audit access controls, audit logs, and breach response protocols for ACO-related systems and clinical workflows.

Fraud, Abuse & Program Integrity

• Ensure compliance with the Physician Self-Referral Law (Stark), Anti-Kickback Statute, and False Claims Act, particularly regarding shared savings distributions, provider incentives, Voluntary Alignment compensation, and clinical interventions funded by ACO savings.
• Develop and monitor policies governing provider bonuses, APP RVU enhancements, and any performance-based payments tied to ACO outcomes.
• Conduct and manage internal audits of coding, documentation (including HCC capture and MEAT criteria), and billing practices that impact risk adjustment and quality scores.

Operational & Clinical Compliance Support

• Partner with clinical and operational leaders to embed compliance into core ACO workflows, including treat-in-place protocols, CCM/PCM, Annual Wellness Visits, Advance Care Planning, SNF Command Center escalations, and night/weekend telemedicine coverage.
• Support accurate and compliant documentation practices that drive HCC recapture, quality measure performance, and reduction of avoidable admissions, readmissions, and ED visits.
• Provide compliance guidance on the rollout and expansion of Medrina Connect and related technology platforms.

Program Management & Culture

• Develop, implement, and update compliance policies, procedures, and training programs for physicians, APPs, care coordinators, and administrative staff across IM and PM&R teams.
• Lead the Compliance Committee, manage internal investigations, and serve as the primary liaison with CMS, external auditors, and legal counsel.
• Monitor regulatory updates related to LEAD, MSSP, and value-based care models and translate them into actionable operational changes.
• Foster a culture of compliance and ethical conduct while enabling innovation in post-acute and long-term care delivery.

Job Requirement: (list required education/degree, licensure, certifications, specific experience)

• Bachelor’s degree required; advanced degree (JD, MHA, MPH, or equivalent) strongly preferred.
• Minimum of 8–10 years of progressive compliance experience in healthcare, with at least 5 years in ACO, Medicare Advantage, MSSP, ACO REACH, or similar value-based care programs.
• Deep knowledge of CMS ACO regulations, HIPAA, Stark Law, Anti-Kickback Statute, and quality reporting requirements.
• Experience with high-needs or post-acute populations, risk adjustment, voluntary alignment, or shared savings models preferred.
• Demonstrated ability to build and lead compliance programs in a multi-specialty, multi-state physician organization.
• Strong analytical, communication, and stakeholder management skills; ability to translate complex regulations into practical operational guidance.
• Certification as a Certified in Healthcare Compliance (CHC) or equivalent preferred.
• Prior work with CMS Innovation Center models (REACH, Next Generation ACO, or similar).
• Familiarity with long-term care, skilled nursing, assisted living, or dual-eligible populations.
• Experience supporting technology platforms used for care coordination, predictive analytics, or real-time monitoring.
• Track record of successful CMS audits, OIG interactions, or compliance program maturity assessments.

Physical Requirements: list any lifting, sitting, standing, climbing requirements, if any

1. This is a full-time remote, work-from-home position, primarily working during standard business hours handling sensitive and confidential information. Work must be performed in a private and secure setting requiring reliable internet and phone connectivity.
2. Ability to communicate via virtual/online meetings daily with a camera on as well as being responsive in a timely manner during work hours via email, MS Teams and phone.
3. Ability to travel quarterly for training, meetings, on-site visits.
4. Ability to sit, stand, and walk for extended periods.
5. Ability to lift and move up to 25 pounds.

EOE/M/F/Vet/Disability:

We are an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.