Skip To Content
Finance@2X
J196665

Director Risk & Compliance Management

Highmark Health

  • Company Hignmark Health
  • Home, PA
  • Finance
  • Full time
  • Day (United States of America)

Company :

Highmark Health

Job Description : 

JOB SUMMARY

This job is responsible for the day-to-day direction of all risk and compliance assessment activities of Highmark Health across a broad range of frameworks including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc.  The incumbent will partner with the organizational risk and business partners, the technology organization, and global delivery teams to meet Highmark Health’s mission requirements in a manner consistent with the enterprise risk appetite.  Must have a proactive mindset and approach, and feel comfortable working in a highly matrixed environment.  


ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Directs global teams participating in new product development, system initiatives and other projects to ensure potential risk and compliance related issues are adequately addressed. Makes needed adjustments to the organization’s risk and compliance risk profile and provide recommendations to adjust monitoring and testing plans, if appropriate.  Work with business and technology delivery teams to define and maintain an effective suite of controls adapting to changes in products, business processes and technology solutions
  • Directs global teams delivering both company and third-party risk, compliance, security, privacy, and assessment activities, across a broad range of frameworks, contracts, and governing bodies, including NIST, HITRUST, PCI, HIPAA, SOC, MAR, CMS, JCAHO, NCQA, the BCBSA, etc. and collaborates with other control partners (e.g. Audit, Legal, Quality and Safety) and regulatory examiners to streamline second line of defense coverage.  Directs the maintenance of accurate and continuously updated inventory of controls including their objectives, processes, and responsible control owner.
  • Directs global teams responsible for structuring risk decisioning recommendations (e.g. avoid, mitigate, transfer, accept), developing plans of action, and memorializing outcomes against those plans.  Where risks exceed organizational tolerances, escalate decisioning as appropriate to senior management and governing committees for review.  In collaboration with Risk Partners, supports clear and comprehensive communication and reporting of decision tradeoffs for business unit leadership. 
  • Actively collaborates and presents with Risk Partner and Business Unit executives in customer and regulator meetings (Insurance Department, HHS/CMS, Department of Health) on key risk and compliance related activities, issues, and remediation, promoting effective relationships.
  • Directs global teams performing vendor risk management, including implementation, development, and maintenance of the internal and external vendor governance framework.  In partnership with Legal, Procurement, and Strategic Initiatives team, performs risk, compliance, quality, resiliency, and security term negotiations on behalf of organization with suppliers.  
  • Directs global teams reviewing internal products, processes, policies and procedures, marketing programs, advertising materials and other communications to identify applicable regulatory risks and related controls. 
  • Other duties as assigned or requested.


EDUCATION


Required

  • Bachelor's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or Related Field


Substitutions

  • 6 years of related and progressive experience in lieu of Bachelor's degree

Preferred

  • Master's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or Related Field

EXPERIENCE


Required

  • 5 years of overseeing privacy, risk, audit, and/or compliance teams

To Include

  • 5 years in leadership roles, preferably in an Audit or Compliance discipline in a Healthcare or Healthcare related industry
  • 5 years of interacting with regulators, auditors, and oversight bodies

Preferred

  • 5 years of contract negotiation


LICENSES or CERTIFICATIONS


Required

  • None

Preferred

(Any of the Following)

  • Certified Public Accountant (CPA)
  • Cybersecurity and Infrastructure Security Agency (CISA)
  • Certified Information Privacy Professional (CIPP)
  • Certified Information Systems Security Professional (CISSP)


SKILLS

  • Demonstrate expert knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly as applied to healthcare (payer and provider) business processes
  • Knowledge of relevant regulatory guidelines, vendor management, sourcing and procurement, and completing assessments of vendors 
  • Excellent resource and project planning capabilities, decision making skills, history of results-oriented delivery, and effective team building across a cross-campus and diverse team of management and staff
  • Strong written and verbal communication skills for diverse audiences (senior management, board, peer, and team)
  • Strong relationship building skills and ability to influence with and without authority in a matrixed organization 
  • Highly developed leadership qualities with an ability to motivate and inspire a group of individuals to achieve superior results
  • High capacity to think analytically, interpret information / observations, apply judgment and make effective, strategic decisions


Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Referral Level Payout 3

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

California Consumer Privacy Act Employees, Contractors, and Applicants Notice


Thumbnail Join Talent Community@2X

Connect with a career that’s right for you.

Introduce yourself and we'll get in touch monthly to share career insights and company news.

Join Our Talent Community