Health Plan San Joaquin
Compliance Program Manager Medicare
Health Plan San Joaquin, French Camp, California, United States, 95231
The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
We are currently hiring a Compliance Program Manager Medicare to join our team!
Must reside in California - remote position.
What You Will Be Doing:
Under general supervision, the Compliance Program Manager (Medicare) is responsible for managing day-to-day communication, programmatic processes, requirements, and governance of the Medicare D-SNP program per regulatory guidance published by the Centers for Medicare & Medicaid Services (CMS). Work is varied and moderately complex and requires a moderate degree of discretion and independent judgement.
Supervises
None
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
Essential Functions
Represent HPSJ at CMS webinars, office hours, and other events to gather critical information about program updates and communicate directly with CMS staff.Drive the execution of key initiatives to support the program success and ensure key CMS deadlines are met.Represent and communicate program updates and performance results at HPSJ in multiple forums, internal and external.Monitor critical CMS requirements and timelines to ensure deliverables are completed accurately and on time.Identify and implement best practices for completing CMS program deliverables across HPSJ and Third Party partners as needed.Educate and work collaboratively with HPSJ leadership to build understanding of the program model and drive improvements internally and with HPSJ's Third Party partners as needed.Collaborate with HPSJ's Compliance, Medi-Cal Program and business teams to ensure adherence to all program policies and procedures.Review and interpret complex program model documents and communications to guide important operations, finance, legal, and analytics-related activities.Maintain critical documentation for program participation and own the ongoing submission process to CMS.Lead or participate in the strategy and implementation of new program features and available benefits by developing tactical plans, cross-functional relationships, internal alignment, and education.Support the governance of compliance program, including the development of meeting content and coordination of Commission approvals.Share program learnings and insights to inform HPSJ's policy and advocacy work.Conduct relevant training and education, as needed.What You Have:
Education and Experience
Required
Bachelor's Degree; andAt least two-years of experience as a program or project manager in a healthcare environment; andAt least two years of experience in managing Medicare D-SNP or Medicare D-SNP programs; orEquivalent combination of education and experience.Preferred
Master's Degree in Business Administration, Public Health, Health Administration or related field.PMP and/or LEAN/Six Sigma certificationExperience with Medi-Cal, Medicare D-SNP, DMHC and DHCS regulations and contract requirements.Experience with managed care operationsLicenses, Certifications
None required.
What You Bring:
Knowledge, Skills, Abilities and Competencies
Required
Demonstrates strong program management, data analysis, project design, effective communication and subject matter expert skills.In-depth knowledge of health plan functions and interactions as they relate to third-party entities and their contractual relationships with HPSJ.In-depth knowledge of contracting regulations and best practicesKnowledge of and ability to effectively apply the principles and best practices of project management, including but not limited to: project lifecycle, scope definition and management, planning and scheduling, monitoring, communication cycles, project team and risk management.Builds partnerships and works collaboratively with others to meet shared objectives.Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals and groups inside and outside of HPSJ.Strong presentation skills, including but not limited to the ability to tailor presentations to a specific audience, and identify key messages.Strong problem solving and analytical skills, with ability to determine key issues, develop effective action plans, including escalation, and implement to successful conclusion.Strong leadership skills, including but not limited to the ability to influence without authority and motivate others; ability to hold third parties accountable for performance.Produces work that is accurate and complete.Produces the appropriate amount of work.Actively learns through experimentation when tackling new problems, using both successes and failures to learn.Rebounds from setbacks and adversity when facing difficult situations.Knows the most effective and efficient process to get things done, with a focus on continuous improvement.Ability to work independently and as part of a team.Ability to read, understand and apply complex written guidelines, instructions and other materials.Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.Strong knowledge of change management theory and ability to implement and manage effectively.Commitment to and ability to facilitate the adoption of HPSJ's strategy, vision, mission and values.Proven arithmetic skills.Advanced skills in Word, Excel, PowerPoint, and Visio.Proficient with MS Excel, Power BI or other dashboarding tools.Intermediate skills in SharePoint.Ability to speak, be understood, read and write in English.Ability to handle confidential information with appropriate discretion.Preferred
Experience with Medi-Cal and Medicare D-SNP managed care operations.Knowledge of the compliance oversight requirements, regulations and/or processes.What You Will Get:
HPSJ Perks:
Competitive salaryRobust and affordable health/dental/vision with choices in providersGenerous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee's birthday, and 9 paid holidays)CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution planTwo flexible spending accounts (FSAs)Employer-Paid Term Life and AD&D InsuranceEmployer-Paid Disability InsuranceEmployer-Paid Life Assistance ProgramHealth AdvocacySupplemental medical, legal, identity theft protectionAccess to exclusive discount mallEducation and training reimbursement in addition to employer-paid elective learning courses.A chance to work for an organization that is mission-driven - our members and community are at the core of everything we do.A shorter commute - if you're commuting from the Central Valley to the Bay Area.Visibility and variety - you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.
We are currently hiring a Compliance Program Manager Medicare to join our team!
Must reside in California - remote position.
What You Will Be Doing:
Under general supervision, the Compliance Program Manager (Medicare) is responsible for managing day-to-day communication, programmatic processes, requirements, and governance of the Medicare D-SNP program per regulatory guidance published by the Centers for Medicare & Medicaid Services (CMS). Work is varied and moderately complex and requires a moderate degree of discretion and independent judgement.
Supervises
None
Our Vision:
Continuously improve the health of our community.
Our Mission:
We provide healthcare value and advance wellness through community partnerships.
Essential Functions
Represent HPSJ at CMS webinars, office hours, and other events to gather critical information about program updates and communicate directly with CMS staff.Drive the execution of key initiatives to support the program success and ensure key CMS deadlines are met.Represent and communicate program updates and performance results at HPSJ in multiple forums, internal and external.Monitor critical CMS requirements and timelines to ensure deliverables are completed accurately and on time.Identify and implement best practices for completing CMS program deliverables across HPSJ and Third Party partners as needed.Educate and work collaboratively with HPSJ leadership to build understanding of the program model and drive improvements internally and with HPSJ's Third Party partners as needed.Collaborate with HPSJ's Compliance, Medi-Cal Program and business teams to ensure adherence to all program policies and procedures.Review and interpret complex program model documents and communications to guide important operations, finance, legal, and analytics-related activities.Maintain critical documentation for program participation and own the ongoing submission process to CMS.Lead or participate in the strategy and implementation of new program features and available benefits by developing tactical plans, cross-functional relationships, internal alignment, and education.Support the governance of compliance program, including the development of meeting content and coordination of Commission approvals.Share program learnings and insights to inform HPSJ's policy and advocacy work.Conduct relevant training and education, as needed.What You Have:
Education and Experience
Required
Bachelor's Degree; andAt least two-years of experience as a program or project manager in a healthcare environment; andAt least two years of experience in managing Medicare D-SNP or Medicare D-SNP programs; orEquivalent combination of education and experience.Preferred
Master's Degree in Business Administration, Public Health, Health Administration or related field.PMP and/or LEAN/Six Sigma certificationExperience with Medi-Cal, Medicare D-SNP, DMHC and DHCS regulations and contract requirements.Experience with managed care operationsLicenses, Certifications
None required.
What You Bring:
Knowledge, Skills, Abilities and Competencies
Required
Demonstrates strong program management, data analysis, project design, effective communication and subject matter expert skills.In-depth knowledge of health plan functions and interactions as they relate to third-party entities and their contractual relationships with HPSJ.In-depth knowledge of contracting regulations and best practicesKnowledge of and ability to effectively apply the principles and best practices of project management, including but not limited to: project lifecycle, scope definition and management, planning and scheduling, monitoring, communication cycles, project team and risk management.Builds partnerships and works collaboratively with others to meet shared objectives.Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people.Strong oral and written communication skills, with the ability to communicate professionally to diverse individuals and groups inside and outside of HPSJ.Strong presentation skills, including but not limited to the ability to tailor presentations to a specific audience, and identify key messages.Strong problem solving and analytical skills, with ability to determine key issues, develop effective action plans, including escalation, and implement to successful conclusion.Strong leadership skills, including but not limited to the ability to influence without authority and motivate others; ability to hold third parties accountable for performance.Produces work that is accurate and complete.Produces the appropriate amount of work.Actively learns through experimentation when tackling new problems, using both successes and failures to learn.Rebounds from setbacks and adversity when facing difficult situations.Knows the most effective and efficient process to get things done, with a focus on continuous improvement.Ability to work independently and as part of a team.Ability to read, understand and apply complex written guidelines, instructions and other materials.Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines.Strong knowledge of change management theory and ability to implement and manage effectively.Commitment to and ability to facilitate the adoption of HPSJ's strategy, vision, mission and values.Proven arithmetic skills.Advanced skills in Word, Excel, PowerPoint, and Visio.Proficient with MS Excel, Power BI or other dashboarding tools.Intermediate skills in SharePoint.Ability to speak, be understood, read and write in English.Ability to handle confidential information with appropriate discretion.Preferred
Experience with Medi-Cal and Medicare D-SNP managed care operations.Knowledge of the compliance oversight requirements, regulations and/or processes.What You Will Get:
HPSJ Perks:
Competitive salaryRobust and affordable health/dental/vision with choices in providersGenerous paid time off (accrue up to 3 weeks of PTO, 4 paid floating holidays including employee's birthday, and 9 paid holidays)CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution planTwo flexible spending accounts (FSAs)Employer-Paid Term Life and AD&D InsuranceEmployer-Paid Disability InsuranceEmployer-Paid Life Assistance ProgramHealth AdvocacySupplemental medical, legal, identity theft protectionAccess to exclusive discount mallEducation and training reimbursement in addition to employer-paid elective learning courses.A chance to work for an organization that is mission-driven - our members and community are at the core of everything we do.A shorter commute - if you're commuting from the Central Valley to the Bay Area.Visibility and variety - you have a chance to work with people at all levels of the organization, and work on diverse projects.
We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.
HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.
Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.