RONALD MCGINNIS
Signal Hill,CA
Summary
Results-driven Vice President with extensive experience in compliance and privacy management. Expertise in developing and monitoring compliance programs, ensuring readiness for audits, and fostering relationships with regulatory authorities. Demonstrated ability to lead teams and enhance organizational effectiveness through strategic compliance initiatives.
Overview
35
35
years of professional experience
Work History
Senior Vice President Chief Compliance & Privacy Officer
AltaMed Health Network
Montebello
02.2025 - Current
- Reporting to the Plan President with responsibility for overall Health Plan Compliance & Privacy.
- Oversaw internal quality monitoring and collaborated with operational business owners to ensure ongoing compliance readiness for federal and state audits.
- Audited and managed operations of all downstream vendors for compliance with regulatory requirements.
- Cultivated collaborative relationships with Federal and State auditors to facilitate effective audit processes.
Vice President of Compliance
The Prosper Group
Remote
01.2025 - Current
- Developed, implemented, and monitored compliance programs that helped clients stay within legal and ethical boundaries.
- Assisted clients in identifying and assessing compliance areas, ensuring alignment with regulatory standards.
- Analyzed industry trends and tracked competitor activities to guide strategic compliance initiatives.
- Delivered training sessions to staff and management to enhance compliance awareness and knowledge.
Vice President of Compliance & Privacy
VERDA HEALTHCARE
01.2024 - 12.2024
- Reported directly to CEO, oversaw and monitored compliance and privacy program across Texas, CA, AZ, ensuring adherence to regulatory standards.
- Oversaw internal quality monitoring, collaborating with operational business owners to maintain ongoing readiness for federal and state audits.
- Eliminated position due to restructuring and all Compliance oversight done by external law firm.
Hybrid Compliance & Privacy Officer
Santa Clara Family Health Plan
Remote
06.2023 - 09.2023
- Reported to Vice President, Government Relations, and Compliance; oversaw and revised compliance program to align with State and Federal requirements for CalAIM and Medicare Advantage.
- Investigated root causes of privacy incidents and breaches, implementing corrective actions to strengthen compliance protocols.
- Served as subject matter expert, collaborating with MSO on compliance best practices and leading internal DHCS and DMHC audits.
- Resigned due to Hybrid roles being eliminated and all staff back into the Santa Clara office.
Chief Compliance & Privacy Officer
AmericasHealth Plan
07.2019 - 03.2023
- Oversaw, monitored, and revised compliance program in alignment with state and federal requirements for 14 FQHC clinics in Ventura County, reporting directly to Interim CEO.
- Chaired monthly Compliance Committee meetings and delivered quarterly compliance updates to Board of Directors, ensuring alignment on compliance initiatives.
- Transitioned compliance plan from restricted to unrestricted Knox-Keene License, enhancing operational capacity.
- Closed health plan operations in March 2023.
- Completed plan closure in 2023.
Vice President
MEDICARE COMPLIANCE SOLUTIONS
Remote
09.2018 - 06.2019
- Consulted directly with Managing Partners to deliver compliance solutions for Medicare Health Plan clients.
- Directed audits and developed corrective action plans to ensure regulatory compliance.
- Guided Medicare appeal and grievance processes to strengthen compliance frameworks.
- Accepted the Chief Compliance role with AmericasHealth Plan.
- Worked at a privately owned healthcare consulting organization that provided Medicare compliance, regulatory, and risk assessment services to Medicare Advantage and Medicare Part D health plans.
Vice President, Compliance
CLINICAL PARTNERS GROUP
Remote
10.2017 - 09.2018
- Reported directly to the Managing Partner.
- Delivered strategic compliance consulting to healthcare clients 'Heal' and 'Butterfly,' enhancing their regulatory adherence and operational integrity.
- Developed and implemented policies and procedures for HIPAA, FWA, and building security review, while establishing the company's ethics and compliance mission statement to guide organizational compliance culture.
- Provided consulting services for global healthcare and life sciences organizations, specializing in CMS compliance and TPA services for health plans and providers.
Western Region Corporate Compliance & Privacy Director
MOLINA HEALTHCARE INC.
Long Beach, USA
09.2015 - 10.2017
- Reported to the Corporate Chief Compliance Officer.
- Oversaw the Medicare Advantage Part D, Marketplace, Medicaid, and Dual eligible populations compliance programs for California, New Mexico, Texas, Utah, Washington, and Wisconsin compliance health plans directors and their support staff, serving over 1.8M members.
- Managed 6 compliance officers and their support staff across multiple states, ensuring adherence to compliance standards.
- Coordinated Molina's corporate and health plan level compliance interface, streamlining communication and processes.
- Left position due to company reorganization as part of a company reorganization where Molina's corporate compliance department was severely reduced; position was eliminated.
Director of Compliance & Regulatory Affairs
WELLCARE
Cypress, USA
04.2013 - 09.2015
- Achieved key compliance with the OIG Corporate Integrity Agreement.
- Supervised Compliance Analyst to ensure compliance with regulatory standards and fostered a culture of accountability.
- Managed relationships with vendors and downstream delegates to ensure compliance.
- Completed the Quarterly Medicare Compliance and Risk reports for the Corporate Compliance Committee.
- Cultivated strong working relationships with regulatory authorities, suppliers, and customers to facilitate compliance and enhance communication.
- Assisted Corporate Chief Compliance Officer with daily compliance functions and oversight of California Health Plans Medicare Advantage and Prescription program for 300K members.
Compliance Officer
UNITEDHEALTHCARE COMMUNITY & STATE
Honolulu, USA
05.2010 - 04.2013
- Reported to the Plan President and Chief Compliance Officer.
- Monitored compliance for all business activities within Medicaid, Duals, and Special Needs plans, ensuring alignment with regulatory standards.
- Co-led NCQA, HSAG, and CAHPS accreditation audits and surveys, achieving excellent ratings and top box scores.
- Supervised 2 exempt FTEs, including 1 manager and 1 analyst, fostering a collaborative compliance environment.
- Relocated to California after accepting a job offer.
Western Region Director of Regulatory Management
ANTHEM BLUE CROSS
Woodland Hills, USA
11.2002 - 07.2009
- Oversaw commercial and senior appeals, grievances, and regulatory complaints to ensure compliance and address member concerns.
- Reported to the Chief Medical Officer and Plan President.
- Chosen by the CEO for the exclusive Anthem Executive Experience Program and AHIP Executive Leadership Program within the first year of hire.
- Led transition process after corporate restructuring to maintain operational continuity and support team integration.
Medicare Appeals & Grievance Manager
UNITEDHEALTHCARE
Cypress, USA
01.1992 - 12.1996
- Reporting to the Director of Member Services.
- Oversaw Medicare Appeals & Grievances process, ensuring compliance with CMS regulations and enhancing member satisfaction.
- Managed approximately 30 FTEs that processed member Appeals & Grievances for CMS region 9.
- Led CMS annual audits and developed Corrective Action Plans to address findings and ensure continuous improvement.
- Maintained oversight and compliance controls for inventory and production while improving member and provider service quality.
- Accepted director position at CalOptima to oversee member services.
Education
MBA - Business
University of Phoenix
Los Angeles, CA07-1996
Bachelor of Science - Communications
University of Texas at Austin
Austin, TX05-1983
Skills
- Regulatory compliance oversight
- Regulatory assessment
- Risk assessment
- Data protection strategy
- Financial management
- Budget management
- Strategic planning
- Change Management
- Coaching and mentoring
- Staff training
- Leadership & Management
- Team leadership
- Compliance training delivery
- Effective communication
Timeline
Senior Vice President Chief Compliance & Privacy Officer
AltaMed Health Network
02.2025 - Current
Vice President of Compliance
The Prosper Group
01.2025 - Current
Vice President of Compliance & Privacy
VERDA HEALTHCARE
01.2024 - 12.2024
Hybrid Compliance & Privacy Officer
Santa Clara Family Health Plan
06.2023 - 09.2023
Chief Compliance & Privacy Officer
AmericasHealth Plan
07.2019 - 03.2023
Vice President
MEDICARE COMPLIANCE SOLUTIONS
09.2018 - 06.2019
Vice President, Compliance
CLINICAL PARTNERS GROUP
10.2017 - 09.2018
Western Region Corporate Compliance & Privacy Director
MOLINA HEALTHCARE INC.
09.2015 - 10.2017
Director of Compliance & Regulatory Affairs
WELLCARE
04.2013 - 09.2015
Compliance Officer
UNITEDHEALTHCARE COMMUNITY & STATE
05.2010 - 04.2013
Western Region Director of Regulatory Management
ANTHEM BLUE CROSS
11.2002 - 07.2009
Medicare Appeals & Grievance Manager
UNITEDHEALTHCARE
01.1992 - 12.1996
MBA - Business
University of Phoenix
Bachelor of Science - Communications
University of Texas at Austin