Program Manager III, Operations Compliance Program

Who We Are

Point32Health 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 Summary

The 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 Operations

• Prepare Operations departments for the CMS’s site visit
• Oversee implementation of  departmental corrective action plans to ensure accurate and timely implementation/execution
• Provide/supervise technical consultation/support to staff and other departments in response to regulatory compliance and policy issues
• Oversee 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 Development
• Manage development, implementation, and monitoring of Compliance and Risk Management activities
• Complete yearly readiness checklist with support from the Operational areas
• Undertake 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 remediation

Manages 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, and
• Identify 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 resources
• Support department in the development of actionable compliance oversight plans

Liaison between Operations with the Compliance Department

• Work collaboratively with  the Compliance Program, the Corporate Compliance and Privacy Program, and other THP departments  on  Medicare compliance matters as necessary or identified
• Serve as the liaison between Compliance,  Legal and the respective business owner(s) for issues pertaining to regulatory compliance, and “interpretation”,  dissemination and implementation of regulatory
• Coordinate materials and reports and provide updates and reports to the appropriate and relevant TMP compliance committee

Liaison with multiple external constituencies including but not limited to: review agencies (OPP, CMS, EOHHS, DOI), accreditation agencies (NCQA), providers, or  high profile employer groups. 

• Disseminate knowledge of THP policies and processes as it is related to the external constituent
• Represent the department as the SME for regulatory site visits
• Act as SME for regulatory submissions and in preparing for site visits
• Support Business owners to assess, implement, and respond to Regulatory Agency requests for process review and update.

Other duties as assigned  

Salary Range

$99,057.74 -$148,586.62

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization.  The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

• Medical, dental and vision coverage

• Retirement plans

• Paid time off

• Employer-paid life and disability insurance with additional buy-up coverage options

• Tuition program

• Well-being benefits

• Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org