[Hiring] Director Medicare Compliance Officer @St. Joseph Hospital & Medical Center

Role Description

As the Medicare Compliance Officer (MCO) for Mercy Care Plan, managed by Aetna, a CVS Company, you will be the cornerstone of our Medicare Advantage (Part C) and Medicare Part D compliance efforts. This critical leadership role is responsible for:

• Designing, implementing, and rigorously overseeing a comprehensive compliance program.
• Ensuring unwavering adherence to all applicable federal and state regulations, as well as CMS requirements.
• Safeguarding the integrity and operational compliance of all Medicare-related activities within Mercy Care Plan.
• Cultivating a culture of compliance and ethical conduct.
• Serving as a trusted advisor and strategic leader.
• Maintaining strong daily operational alignment with the Medicare team.
• Holding direct reporting accountability to the CEO and the Audit and Compliance Committee of the Board.
• Delivering comprehensive formal reports to the Board, CEO, and Compliance Committee quarterly (or as needed) on program status, issue resolution, and oversight activities.
• Overseeing the annual Board Code of Conduct and compliance training, including design, content, distribution, and tracking.
• Developing mechanisms encouraging confidential reporting of suspected fraud, waste, abuse (FWA), or misconduct.
• Promptly responding to FWA reports, coordinating internal investigations, developing corrective actions, and collaborating closely with Internal Audit and SIU.
• Flexibly managing internal investigations and implementing corrective measures (e.g., policy enhancements, disciplinary actions) to ensure compliance and mitigate risk.

Qualifications

• Bachelors or an equivalent combination of directly related work experience and/or education.
• Five (5) years of experience that demonstrates solid Medicare compliance program development, operation, and administration responsibilities.

Requirements

• None specified.

Benefits

• None specified.

Company Description

Join a Legacy of Healing at Saint Joseph’s Hospital and Medical Center (SJHMC) in Phoenix, AZ, a 571-bed nonprofit founded by the Sisters of Mercy over 125 years ago. We're more than a hospital; we're a global destination for life-changing care, embracing patients with humankindness.

• Barrow Neurological Institute (BNI): A world-renowned center for groundbreaking neurological research and innovative treatments.
• Norton Thoracic Institute (NTI): A national leader in advanced thoracic care with pioneering surgical techniques.
• Level I Trauma Center: One of Arizona's busiest ERs, providing immediate, comprehensive care for critically injured patients 24/7.
• Culture of Excellence & Well-being: We care for our people, fostering professional and personal growth.
• Community & Collaboration: Be part of a network committed to global health and well-being.
• Join a Legacy, Shape a Future: Over 20% of our patients travel internationally for our specialized care.