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Medica · 3 days ago

VP Risk and Compliance

Hopkins, MN

Full-time

Hybrid

Director/Executive

$264K/yr - $346K/yr

10+ years exp

Medica is a nonprofit health plan serving over a million members across various states. The VP Risk and Compliance is responsible for overseeing the organization's compliance with regulatory requirements, internal audit functions, and enterprise risk management framework, ensuring a culture of integrity and proactive risk mitigation.

Health CareMedical

No H1B

Responsibilities

Oversee all aspects of Medica's Compliance Program (including both Privacy and Fraud, Waste, & Abuse) and lead a legally and practically effective compliance program consistent with recommended guidelines

Ensure adherence to federal and state regulations, including CMS, HIPAA, and state Medicaid requirements

As necessary, review and revise the compliance program to address new laws, regulations, and changing industry risks

Serve as the primary liaison with regulatory agencies and oversee responses to audits and inquiries

Promote a culture of compliance through training, communication, and leadership engagement

Serve as Medica’s Compliance Officer

Partner with Tech to collaborate with technology‑related risks including cybersecurity, data privacy, digital transformation, and AI‑enabled systems to ensure alignment with enterprise risk appetite

Serve on the Enterprise AI Governance Committee

Oversees the Internal Audit function

Working directly with Audit Committee, performs (or reports) risk analysis to determine areas for audit

Ensures audit findings are addressed with timely and effective corrective actions

Oversees the coordination of regulatory and other external audits and requests for information from federal, state, and local governmental bodies

Monitors audit recommendations and directs follow-up reviews to ensure risk mitigation and improvements are implemented

Develop and maintain the enterprise risk management framework and strategy

Identify, assess, and monitor key organizational risks, including operational, financial, clinical, and reputational risks. Facilitate cross-functional risk assessments and mitigation planning to include, risk appetite development, risk tolerance thresholds risk aggregation and reporting standards, scenario analysis and stress testing

Report risk trends and mitigation efforts to executive leadership

Provide ongoing reports on the status of Medica's Audit, Compliance, and Enterprise Risk management programs and related activities, including those related to privacy and fraud, waste, and abuse, Audit Committee and the Board of Directors

Provide strategic risk insights to inform strategic planning, major investments, partnerships, and product decisions

Respond to issues raised by the Board and/or Audit Committee and act, as appropriate

Lead, mentor, and develop high-performing collaborative teams across Compliance, Risk Management, and Internal Audit

Foster an effective work environment and ensure employees receive appropriate communication, feedback, recognition and development

Determines appropriate staffing levels and resource needs, creates, and manages department and/or project budgets, allocates resources, and approves expenditures

Qualification

Regulatory complianceRisk managementInternal auditHealthcare administrationLeadership experienceInterpersonal skillsCommunication skillsProblem-solvingTeam leadership