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 technology‑related risks including cybersecurity, data privacy, digital transformation, and AI‑enabled 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

Develop and maintain the enterprise risk management framework and strategy

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

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
• 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…