Director Medicare Compliance Officer

Job Summary and Responsibilities

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.

Everyday your expertise will safeguard the integrity and operational compliance of all Medicare-related activities within Mercy Care Plan and you will play a pivotal role in cultivating a culture of compliance and ethical conduct, serving as a trusted advisor and strategic leader.

To be successful in this position you will maintain strong daily operational alignment with the Medicare team while holding direct reporting accountability to the CEO and the Audit and Compliance Committee of the Board, providing a direct and elevated voice for compliance.

• Deliver comprehensive formal reports to the Board, CEO, and Compliance Committee quarterly (or as needed) on program status, issue resolution, and oversight activities, offering critical insights.
• Oversee the annual Board Code of Conduct and compliance training, including design, content, distribution, and tracking, ensuring full regulatory and organizational adherence.
• Develop mechanisms encouraging confidential reporting of suspected fraud, waste, abuse (FWA), or misconduct, with strong protection against retaliation.
• Promptly respond to FWA reports, coordinating internal investigations, developing corrective actions, and collaborating closely with Internal Audit and SIU.
• Flexibly manage internal investigations and implement corrective measures (e.g., policy enhancements, disciplinary actions) to ensure compliance and mitigate risk.

Job Requirements

Required

• Bachelors Degree or an equivalent combination of directly related work experience and/or education or
• An equivalent combination of directly related work experience and/or education and
• Five (5) years of experience that demonstrates solid Medicare compliance program development, operation and administration responsibilities
• Working knowledge of all Microsoft Office products
• Strong business acumen and healthcare industry

#LI-DH

Where You'll Work

Hello Humankindness:

Join a Legacy of Healing at Saint Joseph's Hospital and Medical Center (SJHMC)

Ready to make a real difference? Join 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.

Here, your calling will flourish. We're not just a workplace; we're a community dedicated to a mission of service.

Leaders in Specialized Care:

• 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.

Why SJHMC?

• 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.

This is an invitation to join a family of dedicated professionals at the forefront of medical innovation, united by the power of humankindness.