Program Manager, Regulatory Readiness

Health Plan of San Mateo • CA

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About The Position

Under the direction of the Chief Government Affairs and Compliance Officer (CGACO), the Program Manager, Regulatory Readiness ensures that HPSM achieves and maintains compliance with the requirements and standards for its Medicare Advantage Dual-Eligible Special Needs Plan (DSNP). Serving as a central point of coordination within HPSM, the Program Manager, Regulatory Readiness maintains regular communication with internal and external stakeholders to assess and ensure adherence to Medicare standards, including, but not limited to, Medicare Final Rules and DHCS Policy Guides. The role is responsible for identifying gaps and barriers and developing mitigation strategies to proactively identify and resolve areas of risk.

Requirements

• Bachelor’s degree in business administration, Health Care Management, Public Policy, or related field required; MBA, MPH, or MPP Preferred.
• Minimum three (3) years’ experience with project/program management experience required.
• Minimum three (3) years of managed care experience, preferably with Medicare/Medi-Cal.
• Experience with Medicare Advantage, DSNP, or NCQA for Medicare health plans preferred.
• Experience with quality improvement/process improvement techniques preferred.

Nice To Haves

• Advanced project management, program evaluation, and consulting skills.
• Intermediate continuous improvement or improvement science (Lean, Six Sigma, etc.) skills.
• Intermediate change management and process redesign skills.
• Advanced relationship building and interpersonal communication skills.
• Intermediate financial/quantitative acumen skills.
• Intermediate Microsoft Office Suite skills (e.g., Outlook, Teams, Word, Excel, and PowerPoint).
• Intermediate experience using project management tools.

Responsibilities

• Function as the Medicare subject matter expert (SME) for the organization.
• Manage all aspects of Medicare readiness, including gap analysis, mock auditing, and performance monitoring.
• Schedule and oversee mock file reviews and surveys to assess Medicare readiness.
• Develop and maintain a detailed project plan to assess compliance with Medicare standards.
• Partner with internal stakeholders to ensure understanding of Medicare standards, timelines, and best practices.
• Assist in developing and tracking implementation plans related to Medicare compliance.
• Identify opportunities for innovation and improvement within business units.
• Lead reflection process to assess readiness strengths and opportunities for the coming year.
• Identify and evaluate risks to Medicare readiness. Develop mitigation strategies in consultation with the Chief Government Affairs and Compliance Officer.
• Act as an internal consultant on integrating Medicare standards into operations, project timelines, and reporting.
• Provide technical assistance and best practices to stakeholders per industry insights.
• Leverage external relationships with sibling plans and consultants to inform internal strategies.
• Collaborate with the Compliance Department, Policy Implementation Unit, and NCQA Program Manager to align efforts.
• Find and capitalize on synergies between Medicare and non-Medicare compliance work.
• Contribute to project teams by assigning, monitoring, and guiding the work of team members.
• Serve as the Compliance liaison to broader organizational initiatives and projects as needed.
• Adhere to work performance norms and attendance expectations.
• Perform other duties as assigned.

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees