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Health Plan of San Mateo (HPSM) · 3 months ago

Program Manager, Regulatory Readiness

California, United States

Full-time

Onsite

Mid Level

3+ years exp

Health Plan of San Mateo (HPSM) is focused on ensuring compliance with Medicare standards for its Dual-Eligible Special Needs Plan. The Program Manager, Regulatory Readiness will coordinate efforts to assess and maintain compliance, identify risks, and develop mitigation strategies while collaborating with various stakeholders.

Health CareMedicalNon Profit

Comp. & Benefits

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. Develops 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

Qualification

Medicare Advantage experienceQuality improvement techniquesProject managementChange managementFinancial acumenMicrosoft Office SuiteInterpersonal communicationRelationship buildingCritical thinkingTeam collaborationAdaptability

Required

Bachelor's degree in business administration, Health Care Management, Public Policy, or related field required

Minimum three (3) years' experience with project/program management experience required

Minimum three (3) years of managed care experience, preferably with Medicare/Medi-Cal

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

Extensive knowledge of accrediting/regulatory body requirements

Extensive knowledge of organizational behavior strategies and results-oriented leadership

Working knowledge of change management and process improvement principles

Extensive knowledge of project management practices and methodologies

Demonstrated ability to lead through influence rather than authority

Demonstrated ability to think critically and make informed decisions

Ability to work cooperatively with others and support team decisions

Ability to communicate effectively, both verbally and in writing

Ability to adapt to changes in priorities or requirements

Preferred

MBA, MPH, or MPP Preferred

Experience with Medicare Advantage, DSNP, or NCQA for Medicare health plans preferred

Experience with quality improvement/process improvement techniques preferred

Company

Health Plan of San Mateo (HPSM)

The Health Plan of San Mateo (HPSM) is a local non-profit health care plan that offers health coverage and a provider network to San Mateo County's under-insured population.

Founded in 1987

South San Francisco, California, USA

201-500 employees