• Policies, procedures, standards, and compliance controls. Direct the development, review cycle, maintenance, publication, and operationalization of the Code of Conduct, compliance policies, procedures, standard work, and related controls. Coordinate regulatory research and interpretation with OGC, program leadership, and subject-matter experts; oversee policy life cycle controls, documentation, approvals, acknowledgments, exceptions, and implementation follow-up; and verify that written requirements remain aligned with actual operational practices.
• Effective reporting channels, compliance concerns, investigations, escalation, and corrective action. Oversee accessible and confidential reporting channels and the end-to-end compliance concern life cycle, including intake, logging, triage, assignment, review or investigation, documentation, disposition recommendations, corrective or preventive actions, follow-up, and closure. Establish and administer consistent escalation, decision-routing, and status-reporting protocols; provide timely, appropriate updates to the CCO and other authorized leaders or governance bodies; maintain complete, defensible case records; coordinate appropriate referrals; and promptly elevate high-risk, sensitive, legally significant, executive-level, or reputational matters to the CCO.
• Metrics, reporting, program evaluation, and GRC enablement. Establish program measures and service expectations; monitor trends, aging, timeliness, closure, training, policy, monitoring, and corrective-action data; prepare reports for the CCO, Compliance Committee, and executive leadership; conduct or coordinate periodic program-effectiveness assessments; recommend improvement actions; and serve as Compliance Office business owner for relevant ServiceNow/GRC workflows, requirements, data quality, dashboards, access controls, and adoption.
Knowledge, Skills & Abilities (KSAs): Knowledge of: • Effective compliance program principles, including HHS OIG guidance and the operation of the seven elements of an effective compliance program • Compliance concern intake, triage, fact-finding, investigation, evidence management, root-cause analysis, referrals, corrective action, and closure validation • Risk-based compliance assessment, monitoring, auditing, control evaluation, external-audit coordination, and findings-management practices • Enterprise compliance governance, compliance committees, federated compliance models, escalation protocols, and defensible decision documentation • Medicaid, healthcare, managed-care, fee-for-service, federal award, public-sector, privacy, confidentiality, ethics, conflicts-of-interest, and program-integrity compliance concepts • Federal and Arizona regulatory structures and methods for researching, interpreting, documenting, and operationalizing regulatory requirements • Policy, procedure, standard-work, control, exception, acknowledgment, and records-management lifecycles • Adult-learning principles, role-based training, communication planning, and training-effectiveness evaluation • Compliance metrics, trend analysis, program-effectiveness assessment, dashboards, data integrity, and continuous improvement • GRC concepts and ServiceNow-enabled policy, compliance, issue, investigation, audit, corrective-action, and reporting workflows Skilled in: • Leading professional compliance, policy, investigation, monitoring, and audit personnel through clear assignments, quality expectations, coaching, and accountability • Communicating complex regulatory, compliance, and risk issues to executive leadership, governing bodies, and non-technical stakeholders in a clear and actionable manner • Converting enterprise strategy and regulatory obligations into practical work plans, procedures, controls, training, monitoring, and measurable deliverables • Managing sensitive concerns objectively, consistently, promptly, and with appropriate confidentiality • Preparing concise executive briefings, findings, recommendations, dashboards, and decision memos • Facilitating cross-divisional work and resolving operational barriers while preserving Compliance Office independence and escalation rights • Using risk, trend, workload, and performance data to prioritize resources and improve program effectiveness Ability to: • Exercise sound judgment without exceeding delegated authority and recognize matters requiring CCO, executive, cross-divisional, or regulator involvement • Lead through influence in a federated compliance environment • Build effective partnerships across diverse stakeholder groups • Coach and develop compliance professionals • Ensure investigations, monitoring, and corrective actions are adequately documented and capable of withstanding audit or regulatory scrutiny • Influence leaders and risk/control owners who do not report directly to the position • Balance prevention, education, monitoring, investigation, remediation, and enforcement considerations in a complex public Medicaid environment • Manage competing priorities in a complex regulatory environment • Foster a culture of accountability, transparency, and continuous improvement • Maintain trust, neutrality, discretion, accessibility, and professional independence • Support compliance oversight activities involving contractors, vendors, delegated entities, and other third parties as assigned Qualifications: Minimum: • Bachelor’s degree in compliance, business administration, public administration, health administration, law, accounting, auditing, or a closely related field and five years of progressively responsible experience in compliance, regulatory oversight, audit, investigations, internal controls, risk management, or a related function, including two years of supervisory or program-lead