VP Risk and Compliance

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm, and every member feels valued.

The VP Risk and Compliance is a strategic executive leader responsible for overseeing the organization's compliance with regulatory requirements, internal audit functions, and enterprise risk management framework. This role ensures the health plan maintains a culture of integrity, accountability, and proactive risk mitigation across all lines of business including Medicaid, Medicare, Commercial, and Individual markets. The VP Risk and Compliance reports directly to the Audit Committee and a dotted line to the Chief Legal Officer. Perform other duties assigned.

Key Accountabilities:

• Compliance
  
  
  
  • 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 technologyrelated risks including cybersecurity, data privacy, digital transformation, and AIenabled systems to ensure alignment with enterprise risk appetite
  • Serve on the Enterprise AI Governance Committee
  
  
  
  
• Internal Audit
  
  
  
  • 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
  
  
  
  
• Enterprise Risk Management
  
  
  
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    Develop and maintain the enterprise risk management framework and strategy

    
    
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    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

    
    
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    Report risk trends and mitigation efforts to executive leadership

    
    
  
  
  
  
• Executive Leadership & Board of Directors
  
  
  
  • 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
  
  
  
  
• Team Leadership
  
  
  
  • 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
  
  
  
  

Required Qualifications:

• Bachelor's degree in business, healthcare administration, or related field, plus 10 years of working experience and 8 years of leadership experience

Preferred Qualifications:

• Strong understanding of regulatory environments and compliance program guidelines in the health care/managed care industry
• Demonstrated effectiveness in risk assessment, risk mitigation and compliance
• Extensive knowledge of internal controls, audit standards and audit techniques
• Demonstrates accountability for the well-being of the larger organization
• Strong interpersonal skills to influence and drive change across the organization
• Excellent verbal and written communication skills with all levels of the organization
• Creativity in identifying and implementing solutions to complex issues
• Strong self-initiative and self-motivation
• Ability to create and lead a team environment in which conflicts and challenges can be successfully resolved

This position is an Office role, which requires an employee to work onsite at our Minnetonka office, on average, 3 days per week.

The full salary grade for this position is $264,000-$396,000. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $264,000-$346,500. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.