UpStream is a trusted partner to primary care physicians, helping them focus on what is most important, the patient. We support the delivery of value-based care for seniors and people living with chronic conditions. Our comprehensive solution allows physicians to prioritize patient care while our value-based care model ensures effective condition management. UpStream does this in part by participating as an accountable care organization in CMS’ ACO REACH model and assuming full financial risk on Medicare Advantage contracts, in which our partner physicians participate.

How you’ll help

As the Vice President & Chief Compliance Officer at UpStream, you’ll provide leadership and direction on the organization’s compliance programs, policies, reporting and practices that align with the company’s strategic growth plans. The Vice President & Chief Compliance Officer owns the governing policies and related framework for the organization, while also ensuring all activities follow regulatory guidelines and requirements related to the governance of UpStream as well as industry-specific and market-specific laws. This position oversees internal controls, auditing systems and monitors and reports on regulated activities and processes. This role is also responsible for developing risk-based compliance testing of current procedures and controls to identify, detect and correct areas of non-compliance. The Vice President & Chief Compliance Officer is responsible for maintaining and expanding visibility for the corporate compliance program at all levels throughout the organization and effectively collaborating with key stakeholders to promote compliance. Additionally, this role will evaluate and implement changes to compliance processes due to new or amended regulations.

What you’ll do

• Plan and direct programs, policies and practices to ensure that all business units’ activities are in compliance with regulatory requirements, including healthcare regulatory risks such as the federal Anti-Kickback Statute and privacy law
• Oversee the enhancement and implementation of an effective compliance program in line with the Department of Justice requirements and guidance
• Effectively manage a team of compliance professionals
• Support the businesses goals while building and maintaining a strong culture of compliance, by among other things, implementing effective and business-savvy policies, procedures and training; ensuring open and effective lines of communication at all levels of the organization; supporting investigations, risk assessments, audit and monitoring activities; and driving enterprise-wide compliance and regulatory affairs initiatives
• Establish and support effective business processes and controls to ensure the organization is satisfying its regulatory and compliance obligations, including remediating any identified gaps in a timely fashion
• Establish effective partnerships across the business and enabling functions, such as Clinical, Legal, Human Resources, IT, Security, etc.
• Track laws and regulations that might affect the organization’s policies and implement changes as necessary
• Demonstrate an expertise in a variety of the company’s practices and procedures, including value-based care, Medicare and Medicare Advantage operations
• Develop major departmental objectives to support broader corporate functions
• Approve policies developed within various sub-functions and departments
• Possess comprehensive knowledge of the overall department function
• Support the Chief Legal Officer in broader UpStream initiatives

Experience and skills you’ll need:

• Master's degree required, Juris Doctor preferred
• Minimum of 10 years relevant work experience, including experience working in healthcare compliance programs focused on healthcare regulatory risks
• Broad experience planning, developing, implementing, monitoring and managing compliance programs
• Proven track record creating the foundational elements of an effective compliance program, such as drafting policies, developing and delivering training, and implementing effective compliance auditing and monitoring of programs
• Significant experience with the relevant laws, rules and regulations
• Familiarity with state and federal regulatory agencies that govern companies in the value-based care setting, specifically CMS, OCR and DOJ
• Familiarity with some or all of the following is strongly preferred: Risk adjustment factor coding, chronic care management services and employment/human resources law
• Significant experience working collaboratively on cross-functional and cross-divisional teams
• Demonstrated experience developing strong relationships across a company, ideally in a start-up environment
• Significant experience training, coaching, and retaining team members

Additional Knowledge and Skills preferred:

• Unquestioned ethics, judgment, integrity and courage
• Exceptional written and oral communication skills, including the ability to communicate amongst all organizational levels
• Ability to manage a team, engage employees and function in a start-up environment
• Advanced project management skills
• Strong influencing and partnership skills
• Ability to remain calm and flexible under pressure
• Effective team player
• Relationship builder
• Strategic, business oriented and pragmatic
• Strong implementer

Location/working arrangements

• Remote from Eastern or Central Time Zone
• Occasional travel required to Greensboro, NC