Program Manager III, Operations Compliance Program

Who We ArePoint32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.Job SummaryThe Program Manager III manages programs and projects with significant complexity, risk and/or cost that support the Operation Quality and Compliance Program. Initial key responsibilities will include medium to large scale regulatory and compliance projects and initiatives. Responsibilities include successful implementation of large cross-functional projects to support the program(s), working closely with the appropriate Point32Health staff to manage programs/projects, performing thorough and detailed policy and impact analysis, leading and/or representing the program in change initiatives that affect multiple departments. The Program Manager III evaluates the cost and feasibility of multiple options/alternatives to resolve program issues and to make recommendations on those issues that best meet program and corporate Point32Health, as well as objectives. Change to ongoing programs at this level will usually require facilitating cross-departmental meetings as well as ensuing alignment with federal and state mandates, including CMS and other regulatory oversight bodies. The Program Manager III will also interact directly and regularly with leadership within the department and within Point32Health and others to accomplish successful program management.Job Description KEY RESPONSIBILITIES/ESSENTIAL FUNCTIONS* (in order of importance)Compliance Oversight for OperationsPrepare Operations departments for the CMS’s site visitOversee implementation of departmental corrective action plans to ensure accurate and timely implementation/executionProvide/supervise technical consultation/support to staff and other departments in response to regulatory compliance and policy issuesOversee design, content and conduct of support and compliance training activities for the Operations department with assistance from Corporate Compliance and/or Operation Quality Assurance and Learning and DevelopmentManage development, implementation, and monitoring of Compliance and Risk Management activitiesComplete yearly readiness checklist with support from the Operational areasUndertake investigations of regulatory and compliance inquiries prepare reports and monitor remediation.Responsible for the implementation and oversight of applicable regulatory changes; responsible to review and work with the department manager and supervisors to update current processes to remain in compliance with applicable standards and assist them in understanding how these standards impact their work and overall company and regulatory compliance.Manage, document and maintain a coordinated regulatory compliance program that meets the expectations of the TMP and Corporate Compliance program by monitoring federal and state guidance, regulations and other sources of requirements, investigating regulatory and compliance inquiries, preparing reports and monitoring remediationManages major compliance programs with significant cross-functional interface with significant complexity and risk. Responsibilities include development of new programs as well as management of ongoing programs.Develop and implement programs, policies, procedures and practices designed to ensure compliance with the requirements of State and Federal health care programs, andIdentify compliance risks and work to develop and implement mitigation strategies to address identified issues to ensure compliance with these regulations.Represent the departments on regulatory and compliance related work groups and Committees as appropriate.Identify training needs and develops appropriate resourcesSupport department in the development of actionable compliance oversight plansLiaison between Operations with the Compliance DepartmentWork collaboratively with the Compliance Program, the Corporate Compliance and Privacy Program, and other THP departments on Medicare compliance matters as necessary or identifiedServe as the liaison between Compliance, Legal and the respective business owner(s) for issues pertaining to re