Compliance & Privacy Manager – RHTF Program

Summary / Objective:
The Compliance & Privacy Manager – RHTF Program, supports the Chief Compliance, Privacy & Risk Officer in developing, implementing, and overseeing compliance and privacy program activities specific to PSW’s Hawaii Rural Health Transformation Program work under the State Health Planning and Development Agency (SHPDA) arrangement. The role embeds compliance and privacy requirements into clinically integrated network (CIN) development and operations, including governance build, provider readiness assessments, policies and procedures, training, regulatory filings, Advanced Primary Care Management (APCM) guidance, and ongoing program oversight.

The Compliance & Privacy Manager – RHTF Program partners with participating providers, program leadership, governance bodies, legal counsel, and clinical, finance, technology, and network teams to establish practical controls, support compliant implementation, assess risks, and monitor corrective actions and program obligations. The position supports governance development and operational readiness from a compliance and privacy perspective, within delegated authority and in coordination with enterprise standards, without replacing clinical, legal, financial, or operational decision-making authority.

Essential Functions:
• Assess compliance and privacy readiness of participating Hawaii providers, practices, clinics, and other network participants; identify governance, documentation, workflow, data-sharing, and oversight gaps and recommend prioritized remediation.
• Develop, implement, and maintain Hawaii CIN compliance and privacy policies, procedures, tools, assessment templates, obligation trackers, documentation standards, and reporting mechanisms aligned with approved program requirements and PSW enterprise standards.
• Maintain a Hawaii program compliance work plan and requirements calendar identifying accountable owners, deliverables, training, filings, reporting deadlines, monitoring activities, and supporting evidence; track completion and escalate gaps.
• Support Hawaii CIN governance development, including charters, committee responsibilities, delegated authority, conflicts-of-interest processes, approval pathways, and records of decisions, in coordination with program leadership and legal counsel.
• Evaluate compliance and privacy support needs for the Hawaii CIN build and ongoing operations; advise the Chief Compliance, Privacy & Risk Officer on readiness gaps, control ownership, training needs, and program-specific resource constraints.
• Manage assigned Hawaii compliance and privacy program activities, implementation controls, documentation, issue tracking, reporting, and follow-up within delegated responsibilities and in coordination with the Chief Compliance, Privacy & Risk Officer and program leads.
• Provide timely, practical, documented compliance and privacy guidance to Hawaii program teams and participating providers on CIN participation, network workflows, information sharing, and implementation questions.
• Conduct or coordinate assigned Hawaii program compliance, privacy, ethics, and fraud, waste, and abuse investigations, including evidence review, root-cause analysis, corrective action recommendations, and remediation monitoring, with appropriate escalation to enterprise compliance and privacy leadership.
• Conduct or coordinate Hawaii CIN compliance and privacy risk assessments, audits, monitoring, and regulatory readiness reviews; validate corrective actions and maintain evidence supporting program oversight.
• Research applicable Hawaii and federal healthcare, privacy, and program requirements; translate them into operational guidance and coordinate preparation, review, approval, and submission tracking for required program and network filings with authorized owners and legal counsel.
• Develop and deliver role-based compliance, privacy, ethics, and governance training for Hawaii program staff, governance participants, and participating providers; document completion and evaluate understanding of program expectations and escalation pathways.
• Provide compliance guidance and monitoring for APCM implementation and related value-based care initiatives within the Hawaii program, including applicable participation, consent, documentation, billing, and oversight expectations, in partnership with clinical, coding, billing, and legal subject-matter experts.
• Monitor compliance with applicable SHPDA contractual obligations, funding conditions, approved program commitments, reporting requirements, and record-retention expectations; coordinate evidence collection and remediation with program and finance owners.
• Support compliance and privacy oversight of Hawai?i program subcontractors, vendors, business associates, and network participants, including applicable approval requirements, contractual obligations, monitoring, reporting, corrective actions, and supporting documentation.
• Review Hawaii CIN participation, shared-services, vendor, business associate, and data-sharing arrangements for compliance, privacy, security, permitted data use, audit rights, reporting, and oversight considerations; coordinate concerns and proposed safeguards with legal counsel and responsible owners.
• Support compliance and privacy due diligence, onboarding, and implementation readiness for Hawaii CIN participants and program initiatives, including documented participation requirements, policies, training, and operational controls.
• Partner with technology, security, clinical, and operational teams to assess privacy risks in Hawaii CIN data flows, access arrangements, information exchange, and shared-services workflows; document safeguards, accountability, and incident escalation processes.
• Coordinate Hawaii program incident and concern intake with enterprise Compliance, Privacy, Legal, Human Resources, and operational leadership as appropriate; support consistent investigation protocols, confidentiality, nonretaliation, and authorized reporting determinations.
• Prepare Hawaii program compliance and privacy dashboards, readiness summaries, risk analyses, monitoring results, and recommendations for the Chief Compliance, Privacy & Risk Officer, program leadership, and designated governance bodies as assigned.
• Escalate significant, material, or potentially reportable compliance, privacy, regulatory, contractual, operational, or risk matters to the Chief Compliance, Privacy & Risk Officer to support appropriate determination, reporting, and follow-up.
Establish documented handoffs, cross-training, and sustainable compliance and privacy processes for the transition from Hawaii CIN development to ongoing network operations, in coordination with enterprise program owners.

Knowledge / Skills / Abilities:
• Strong working knowledge of healthcare compliance and privacy program principles, including HIPAA, fraud, waste and abuse, investigations, auditing and monitoring, corrective action, third-party oversight, and regulatory expectations.
• Ability to research and apply Hawaii and federal healthcare, privacy, CIN, government-contract, and funding requirements and develop practical compliance guidance for provider-network operations and APCM implementation.
• Strong compliance and privacy program implementation skills, including governance development, provider readiness assessment, policy and procedure development, training, requirements tracking, monitoring, and coordination of regulatory filings and corrective actions.
• Strong investigation, risk assessment, issue management, documentation, root-cause analysis, corrective action, monitoring, escalation, and follow-up skills.
• Ability to review contracts and third-party arrangements for compliance, privacy, data-use, security, reporting, oversight, audit-right, and risk-allocation considerations.
• Strong written, verbal, analytical, organizational, relationship-building, and project follow-through skills, with sound judgment, discretion, professionalism, attention to detail, and ability to appropriately handle confidential and sensitive information.

Supervisory Responsibility:
This position does not currently have direct supervisory responsibility. The Compliance & Privacy Manager – RHTF Program may lead Hawaii program compliance and privacy initiatives, coordinate assigned work, provide subject-matter guidance, and support implementation across participating organizations. Supervisory responsibilities may evolve with approved Hawaii program structure and staffing needs.

Required Education and/or Work Experience:
• Bachelor’s degree in healthcare administration, business, law, public policy, compliance, health information management, nursing, or a related field.
• Five years of progressively responsible experience in healthcare compliance, privacy, regulatory affairs, investigations, audit, legal services, risk management, program management, or a related area.
• Demonstrated experience supporting or managing healthcare compliance or privacy initiatives, including risk assessments, policies and procedures, training, monitoring, regulatory readiness, or corrective action, in collaboration with cross-functional stakeholders.
• Demonstrated experience organizing complex work, developing repeatable processes or tools, and translating regulatory or program requirements into operational practices.

Preferred Education and/or Work Experience:
• Juris Doctor, master’s degree, or other relevant advanced degree.
• Experience supporting clinically integrated networks, provider practices, rural healthcare, shared-services models, APCM or other primary care initiatives, or value-based care arrangements; familiarity with Hawai?i’s healthcare delivery environment.
• Experience with network governance development, provider readiness assessments, healthcare regulatory filings, government-contract or grant compliance, and implementation monitoring.
• Experience reviewing healthcare contracts, vendor or business associate arrangements, or delegated relationships from a compliance, privacy and risk perspective.

Required Certificates, Licenses and Registrations:
• CHC, CHPC, CCEP, or comparable credential (within twelve months of hire).

Travel Requirements:
• Travel may occasionally be required.

Program Funding and Employment Notice
This position supports Physicians of Southwest Washington's Hawaii Rural Health Transformation Program and related healthcare transformation initiatives. The position is funded through one or more state contracts, grants, and other program funding sources. While the organization currently anticipates a multi-year initiative, continued employment is contingent upon the availability of funding, continuation of contractual agreements, successful program performance, regulatory approvals, and ongoing business needs. Nothing in this job description, recruitment process, offer of employment, or subsequent employment relationship shall be construed as a guarantee of employment for any specific duration. Physicians of Southwest Washington reserves the right to modify program structure, organizational assignments, position responsibilities, staffing levels, and employment status if funding, contractual requirements, operational priorities, or business needs change.

*PSW does not typically hire at the top of the pay range *