[Hiring] Director Medicare Compliance Officer @CommonSpirit Health

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, and developing corrective actions.
• Flexibly managing internal investigations and implementing corrective measures (e.g., policy enhancements, disciplinary actions).

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.