Director, Compliance & Government Program
Remote
About Us
Zyter|TruCare is a population health platform that brings together technology, agentic AI, and clinician-led services into one cohesive ecosystem. We help payers and providers run Utilization, Case, and Disease Management on a single platform — and then layer AI to orchestrate work, reduce manual effort, and deliver measurable outcomes.
Our products serve over 56M+ members and patients across 50+ clients, powering the operating systems for payer and provider operations. We combine a digital platform, AI orchestration, and clinical services into a unified equation that simplifies work, improves decisions, and scales outcomes across the care continuum.
Position Summary
Zyter is seeking a seasoned Director of Compliance & Government Programs to lead compliance oversight across our government and commercial healthcare lines of business. This role serves as Zyter’s senior compliance leader for regulatory adherence within Utilization Management (UM), Care Management (CM), and Disease Management (DM) operations—particularly those supporting Medicare Advantage, Medicaid, and delegated entity arrangements, while maintaining alignment across all commercial programs.
Key Responsibilities
- Develop, implement, and oversee Zyter’s corporate compliance framework for UM/CM/DM services across both government and commercial programs.
- Ensure adherence to all state and federal regulatory requirements, including UR filings, TPA licensing, HEDIS/QI standards, CMS regulations, NCQA/URAC accreditation, and other compliance mandates related to utilization review and case management.
- Lead all regulatory submissions and audits (state UR filings, CMS readiness reviews, corrective action plans, delegation oversight, etc.).
- Serve as Zyter’s compliance liaison for government and commercial contracts, ensuring timely and accurate reporting, incident management, and adherence to turnaround-time standards.
- Partner with Product, Clinical, and Client Success teams to align operational processes with applicable state and CMS requirements.
- Monitor evolving federal and state legislation impacting Zyter’s clients and proactively guide updates to policies, procedures, and training.
- Oversee internal auditing, monitoring, and compliance training programs; maintain documentation in accordance with CMS and accreditation body requirements.
- Serve as a consultant for external client compliance needs, including supporting client compliance resources, imparting perspective on project decisions, etc.
Qualifications
- 5–10 years of progressive compliance leadership in healthcare, with a focus on managed care, UM/CM operations, or payer/TPA environments.
- Strong familiarity with Medicare Advantage, Medicaid, and commercial delegated compliance programs.
- Experience managing state UR filings, QI programs, HEDIS reporting, and CMS compliance audits.
- Deep understanding of turnaround-time regulations, delegation oversight, and accreditation standards (URAC, NCQA).
- Bachelor’s degree or a minimum of 10 years of relevant experience required.
- RN preferred but not required.
- Proven ability to collaborate across departments and influence senior leadership.
Preferred
- Experience leading compliance for a delegated entity or TPA performing UM for state or federal programs.
- Knowledge of CMS pilot or demonstration programs (e.g., WISe-R, value-based initiatives).
Zyter|TruCare is an equal opportunity employer committed to fostering an inclusive and diverse workplace. We encourage applications from all qualified individuals.
Perks and Benefits
Our company values are a set of core beliefs held by our organization. They drive how and why we do the things we do. While our business plans and strategies may change, our core values remain unchanged.
Flexible schedule
Open Cafeteria
Team Building Camps
Paid Holidays
Competitive Salary
Servicing around the globe
Zyter|TruCare offers purpose-built technology and services