Chief Ethics, Compliance and Risk Officer

Company

AHI agilon health, inc.

Remote - USA

Chief Ethics, Compliance and Risk Officer

Essential Job Functions:

• Strategic Advisory & Business Partnership Serve as a strategic partner to senior leadership, integrating compliance and ethics considerations into business planning, growth initiatives, and decision-making.
• Advise on healthcare regulatory matters affecting business operations, market strategy, and strategic initiatives across Medicare Advantage, ACO, and value-based care models.
• Support complex transactions, new market expansion, and partner relationships by providing proactive compliance guidance that facilitates execution while protecting the organization.
• Ensure company and partner communications related to Markets, ACO, and Growth achieve business objectives while maintaining regulatory compliance and protecting confidential and proprietary information.
• Partner with senior management to integrate compliance considerations into business planning and decision-making at the enterprise level.

• Compliance Leadership & Risk Management Develop and implement comprehensive compliance and risk management programs aligned with enterprise strategy.
• Oversee compliance operations across healthcare, corporate governance, privacy, and other regulatory domains.
• Design and monitor internal controls and compliance monitoring systems.
• Lead risk assessment initiatives in partnership with enterprise stakeholders, vendors, and business partners.
• Ensure alignment between compliance functions and Compliance/Audit Committee requirements.
• Drive policy development that balances business enablement with regulatory compliance.
• Build and sustain a compliance culture through training, communication, and stakeholder engagement.
• Manage regulatory relationships and coordinate responses to regulatory inquiries.

• Compliance Program Operations Communicate the importance of the Compliance Program to the executive management team, Board of Directors, and the agilon health enterprise; prepare and distribute the written Code of Conduct; set forth the ethical principles and policies which form the basis of the Compliance Program.
• Implement education programs addressing compliance and the Code of Conduct; maintain a retaliation-free internal reporting process, including an anonymous reporting system; collaborate with executive management to effectively incorporate the Compliance Program within system operations and programs.
• Regularly review the Compliance Program and recommend appropriate revisions and modifications, including advising leadership and the Board of Directors of potential compliance risk areas.
• Ensure that internal controls can prevent and detect significant instances or patterns of illegal, unethical, or improper conduct by employees, agents, affiliated providers, or others working with the organization.
• Ensure the agilon health Compliance Program effectively detects and prevents violations of law, regulations, and organization policies, including Medicare billing and marketing regulations, fraud and abuse laws, and policies for the protection of privacy and confidentiality of protected health information.
• Protects protected health information (PHI) in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

• Enterprise Risk Management Lead agilon’s Enterprise Risk Management (ERM) function, establishing the framework, governance structure, risk appetite, and operating cadence in partnership with Internal Audit and senior leadership.
• Design and implement an enterprise risk identification, assessment, and prioritization process that covers strategic, operational, regulatory, financial, and reputational risk domains.
• Partner with Internal Audit to align ERM and audit activities, ensuring risks are appropriately covered, escalated, and tracked without duplication of effort.
• Develop and maintain the enterprise risk register; report on key risk indicators and emerging risks to the CEO, executive team, and Board on a regular cadence.
• Integrate ERM insights into strategic planning, business development, and operational decision-making across the organization.
• Champion a culture of proactive risk awareness; build risk management capabilities across business units through training, tools, and embedded support.

• ACO Program Compliance Support Serve as the primary compliance resource for agilon’s ACO programs, including ACO REACH, MSSP, and ACO LEAD, providing guidance on CMS participation requirements, program integrity obligations, and regulatory compliance.
• Review and advise on ACO participation agreements, CMS data use agreements, and program-related contracting, escalating complex matters to the Chief Legal Officer as appropriate.
• Monitor CMS and CMMI rule making, policy guidance, and program changes affecting agilon’s ACO portfolio; analyze implications and communicate material developments to leadership.
• Support ACO-related compliance training for physician partners, affiliated…