Program Manager Iii, Operations Compliance Program

The Program Manager III manages programs and projects with significant complexity, risk and/or cost. Initial key responsibilities will include medium to large scale 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 business areas. 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 objectives. Change to ongoing programs at this level will usually require facilitating cross-departmental meetings as well as negotiations with multiple parties/partners and contacts to explain and justify the impact. The Program Manager III will also interact directly and regularly with leadership within the business area and within Point32Health and others to accomplish successful program management.

The Program Manager III needs to demonstrate strong professional judgment and apply risk management in highly escalated situations. They need to possess operational process re-engineering skills as well as the ability to understand and clearly document root cause analyses.

Key Responsibilities/Duties – What You Will Be Doing

• Manage development, implementation, and monitoring of compliance and risk management activities.
• Provide/supervise technical consultation/support to staff and other business areas in response to regulatory compliance and policy issues.
• Oversee compliance issue reporting and implementation of Operations business area corrective action plans to ensure accurate and timely implementation/validation.
• Manage, develop as needed, document, and maintain a coordinated regulatory compliance program that meets the expectations of the Point32Health (P32H) 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.
• Undertake investigations of regulatory and compliance inquiries, prepare reports, and monitor remediation.
• Prepare Operations business areas for the CMS Program Audit and other external and internal audits.
• Facilitate meetings with Operations business area management, subject matter experts, and cross-functional stakeholders to review issues of potential noncompliance and provide updates on active initiatives and projects.
• Complete yearly readiness checklist with support from the Operations business areas and prepare documentation for submission to CMS.
• Support the design, content, and conduct of support and compliance training activities for the Operations business areas with assistance from Corporate Compliance and/or Operations Quality Assurance and Learning and Development.
• Responsible for the implementation and oversight of applicable regulatory changes; responsible to review and work with the Operations business area directors, managers, 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.
• Support Business owners to assess, implement, and respond to Regulatory Agency requests for process reviews and updates.

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.

• Identify compliance risks and work with Operations business areas to develop and implement mitigation strategies to address identified issues to ensure continuous compliance.
• Represent the Operations business areas on regulatory and compliance related work groups and Committees as appropriate.
• Support the development of programs, policies, procedures, and practices designed to ensure compliance with the requirements of State and Federal health care programs.
• Support Operations business areas in the development of actionable compliance oversight plans and corrective action plans.

Liaison between Operations with the Compliance Department

• Coordinate materials and reports and provide updates and reports to the appropriate and relevant P32H compliance committees.
• Serve as the liaison between Compliance, Legal, Government Affairs, and the respective business owner(s) for issues pertaining to regulatory compliance, and “interpretation”, dissemination and implementation of regulatory.
• Work collaboratively with the Corporate Compliance and Privacy Programs, and other P32H business areas on compliance matters as necessary or identified.

Other duties as assigned.

EXPERIENCE (minimum Years Required)

Qualifications – what you need to perform the job

• 8-10 years’ business or industry experience.
• Significant business process and program management experience related to the implementation of healthcare insurance business applications and products using industry-standard project and program management tools and techniques with established track record.
• A proven ability to meet deadlines is also required.
• 5-8 years of program management experience, including leading significant cross-functional, high-level initiatives.

Skill Requirements

• Using knowledge of company, able to resolve most roadblocks to program progress. Able to operate in a matrixed environment. May need to coordinate the participation of other internal contacts to develop and or maintain programs.
• Highly developed oral and written communication skills, ability to communicate with and influence internal and external constituents at all levels with confidence.
• Possess strong influencing skills with the ability to manage and motivate both direct and non-direct reports. Must have a demonstrated ability to obtain the confidence and trust of non-reports, resulting in high commitment and cooperation.
• Ability to navigate political issues using advanced organizational knowledge.
• Able to identify risk out of the larger picture and has a proven ability to accurately estimate and plan resource usage. Able to identify and make decisions that serve the best interests of P32H.
• Able to navigate political issues using advanced organizational (P32H) knowledge. Is an effective advocate for program and negotiates/leads others both internally and externally to participate in the program. May be required to coach/mentor less experienced program managers and effectively lead in a matrixed environment.
• Proactively identifies conflict/integration issues and leads team members to parse/synthesize issues of the highest complexity.
• Must have the ability to motivate fellow employees by fostering team spirit, an attitude of cooperation, and a commitment to the organization. Requires well-developed interpersonal skills to act in the capacity of liaison to the user community.
• Ability to present technical information in a way that establishes rapport, persuades others, and gains understanding.
• Strong negotiating, influencing, and advocacy skills, ability to lead others both internally and externally to ensure the success of the program.
• Requires the ability to maintain effective and productive peer relationships.
• Ability to thrive in a matrix-management, hands-on environment that demands a consultative approach and solutions that span multiple environments in a business area.
• High level presentation skills including ability to interface and “sell” new programs and changes to existing programs to a broad range of internal and external contacts, as necessary. Ability to interact with confidence with external and internal stakeholders, including senior management.
• Must be an accomplished multi-disciplinary team-leader and team-builder with hands-on style. Ability to lead teams whose members have diverse professional and educational backgrounds, and to effectively manage difficult group dynamics to effectively reach a positive outcome.
• Detailed content knowledge of the specific program. Must be able to converse and lead dialogue on the subject with minimal direction; advanced training in the field related to the program is preferred.
• Highly developed verbal and written skills, ability to facilitate planning and review sessions with senior management.
• Must be flexible and a proponent/champion of change, able to conceptualize and envision the impact of change, and propose new ways to do business.
• Outstanding communication and relationship management skills required, including the ability to effectively manage difficult group dynamics to effectively reach a positive outcome.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS (include special requirements, e.g., lifting, travel):

• May be required to work additional hours beyond standard work schedule.
• Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
• Must be able to work under normal office conditions and work from home as required.

DISCLAIMER

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities.

TalentBoost is now Ignyte AI.

This job has been posted by Ignyte AI on behalf of Point32Health. Ignyte AI is committed to the fundamental principle of equal opportunity and equal treatment for every prospective and current employee. It is the policy of Ignyte AI not to discriminate based on race, color, national or ethnic origin, ancestry, age, religion, creed, disability, sex and gender, sexual orientation, gender identity and/or expression, military or veteran status, or any other characteristic protected under applicable federal, state or local law

Req ID: R6929