Senior Director of Product Compliance

Position Overview:

Empower. Unite. Care.

Metro Plus Health is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Senior Director of Product Compliance, reporting to the Vice President of Compliance, provides strategic leadership and oversight for Metro Plus Health 's Product Compliance and External Audit functions across all lines of business, including Medicaid, HIV SNP, HARP, CHP, Essential Plan, QHP, Large Group, Medicare, MAP, MLTC, and other integrated products.

This role is responsible for leading the State Product Compliance, Federal and Integrated Product Compliance, and External Audit teams, ensuring organizational readiness for regulatory oversight, driving enterprise-wide implementation of regulatory requirements, and promoting a culture of proactive compliance. The Senior Director serves as a key advisor to executive leadership on regulatory risk, corrective action strategies, audit readiness, and compliance program effectiveness.

The position is responsible for developing compliance strategies that align with organizational priorities, overseeing regulatory implementation efforts, supporting risk assessment activities, and ensuring consistent monitoring and reporting of compliance performance across the organization.

• Provides strategic leadership and oversight for the State Product Compliance, Federal and Integrated Product Compliance, and External Audit teams.
• Responsible for the day-to-day operations, performance, and resource management of Product Compliance and External Audit functions.
• Establishes departmental goals, priorities, and performance metrics aligned with organizational objectives and the Compliance Department's strategic plan.
• Provides leadership, coaching, mentorship, and professional development to Directors, managers, and compliance staff.
• Contributes to the annual compliance risk assessment, collaborating with Compliance and business stakeholders to identify, evaluate, and prioritize regulatory and operational compliance risks.
• Supports the development, execution, and presentation of the Annual Compliance Work Plan and oversees completion of auditing and monitoring activities assigned to Product Compliance.
• Develops, implements, and revises policies, procedures, and departmental standards to ensure compliance with applicable federal and state regulatory requirements.
• Provides regulatory implementation oversight by ensuring applicable regulatory requirements are effectively operationalized by internal business units, delegated entities, and external vendors.
• Evaluates emerging regulatory risks and provides recommendations to executive leadership regarding compliance preparedness, mitigation strategies, and operational impacts.
• Ensures open lines of communication, both internally and externally, so that reports of potential non-compliance are appropriately received, investigated, escalated, and resolved.
• Oversees the identification and resolution of compliance issues and provides guidance to business areas regarding root cause analysis, corrective action development, monitoring methodologies, and regulatory impact assessments.
• Oversees preparation of regulatory disclosures, self-reports, and other compliance-related submissions to federal and state regulatory agencies, as necessary.
• Partners with business areas to develop and enhance monitoring activities and key performance indicators designed to assess ongoing compliance with regulatory requirements.
• Provides oversight of external regulatory examinations, CMS program audits, NYS Department of Health reviews, independent compliance program evaluations, and other compliance-related assessments.
• Oversees organizational audit readiness activities and manages external examinations, regulatory audits, independent assessments, and corrective action governance.
• Monitors progress of corrective actions resulting from audits, investigations, assessments, and regulatory reviews to ensure timely and sustainable remediation.
• Prepares and presents reports, dashboards, risk analyses, and committee materials for senior leadership, the Vendor Delegation Oversight Subcommittee, Internal Compliance Committee, and the Audit and Compliance Committee of the Board of Directors.
• Serves as a voting member of the Vendor Delegation Oversight…