Program Director - Medicare Compliance
About the position
This is a modified hybrid role: 1-2 days per week. Location is Hanover, MD. The Johns Hopkins Health Plan is seeking a driven Program Director - Medicare Compliance to lead our Medicare compliance program and ensure full adherence to CMS and regulatory requirements. This role oversees daily program operations, guides compliance strategy and structure, manages staff, and partners across the organization and with FDRs to promote a strong culture of compliance. The Program Director drives auditing and monitoring efforts, leads key committees, liaises with regulatory agencies, and oversees corrective action and implementation of new guidance to maintain an effective, proactive compliance program. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3.2B business serving nearly 500,000 members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider sponsored health plansābacked by the clinical expertise of Johns Hopkins Medicineāand is poised for future growth. Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered and have a passion to be at the forefront of change, JHHP is the place to call home.
Responsibilities
ā¢ Oversees daily program operations
ā¢ Guides compliance strategy and structure
ā¢ Manages staff
ā¢ Partners across the organization and with FDRs to promote a strong culture of compliance
ā¢ Drives auditing and monitoring efforts
ā¢ Leads key committees
ā¢ Liaises with regulatory agencies
ā¢ Oversees corrective action and implementation of new guidance to maintain an effective, proactive compliance program
Requirements
ā¢ A minimum of 5-7 years in a Medicare Compliance program and 3-5 years of management and supervisory experience
ā¢ Knowledge of CMS Medicare Advantage and Part D contractual and regulatory requirements
ā¢ Expert level knowledge of HIPAA requirements, 42 CFR 422, 42 CFR 423, Inflation Reduction Act, OIG Compliance Guidelines, and other key regulations related to public health
ā¢ Strong critical thinking, strategic problemāsolving, and the ability to communicate complex compliance requirements clearly
ā¢ Candidates should excel in interpersonal communication, customer service, and collaboration across all organizational levels
ā¢ Strong analytical ability, data interpretation skills, and project management capabilitiesāincluding planning, implementation, and reportingāare essential
ā¢ Proficiency with Microsoft Office applications and statistical audit tools is required
ā¢ Ability to research regulations, manage multiple priorities, and meet tight deadlines with minimal supervision
Nice-to-haves
ā¢ Masterās degree or Juris Doctorate preferred
ā¢ Certification in Health Care Compliance, Fraud Examination or Internal Audit is preferred
ā¢ Understanding of Maryland payment methodology and Health Services Cost Review Commission strongly preferred
ā¢ Ideal candidate will come from a health plan background and claims management experience is especially valuable
Benefits
ā¢ Johns Hopkins Health Plans is an organization that recognizes and rewards excellence and encourages professional development.
ā¢ Employee rewards, recognition, camaraderie and support are just a few of our many benefits include tuition assistance, dependent college tuition program, 403(b) retirement savings, health, dental vision and prescription coverage, disability and life insurance, paid time off and holidays.
Apply Now
Apply Now
This is a modified hybrid role: 1-2 days per week. Location is Hanover, MD. The Johns Hopkins Health Plan is seeking a driven Program Director - Medicare Compliance to lead our Medicare compliance program and ensure full adherence to CMS and regulatory requirements. This role oversees daily program operations, guides compliance strategy and structure, manages staff, and partners across the organization and with FDRs to promote a strong culture of compliance. The Program Director drives auditing and monitoring efforts, leads key committees, liaises with regulatory agencies, and oversees corrective action and implementation of new guidance to maintain an effective, proactive compliance program. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3.2B business serving nearly 500,000 members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider sponsored health plansābacked by the clinical expertise of Johns Hopkins Medicineāand is poised for future growth. Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered and have a passion to be at the forefront of change, JHHP is the place to call home.
Responsibilities
ā¢ Oversees daily program operations
ā¢ Guides compliance strategy and structure
ā¢ Manages staff
ā¢ Partners across the organization and with FDRs to promote a strong culture of compliance
ā¢ Drives auditing and monitoring efforts
ā¢ Leads key committees
ā¢ Liaises with regulatory agencies
ā¢ Oversees corrective action and implementation of new guidance to maintain an effective, proactive compliance program
Requirements
ā¢ A minimum of 5-7 years in a Medicare Compliance program and 3-5 years of management and supervisory experience
ā¢ Knowledge of CMS Medicare Advantage and Part D contractual and regulatory requirements
ā¢ Expert level knowledge of HIPAA requirements, 42 CFR 422, 42 CFR 423, Inflation Reduction Act, OIG Compliance Guidelines, and other key regulations related to public health
ā¢ Strong critical thinking, strategic problemāsolving, and the ability to communicate complex compliance requirements clearly
ā¢ Candidates should excel in interpersonal communication, customer service, and collaboration across all organizational levels
ā¢ Strong analytical ability, data interpretation skills, and project management capabilitiesāincluding planning, implementation, and reportingāare essential
ā¢ Proficiency with Microsoft Office applications and statistical audit tools is required
ā¢ Ability to research regulations, manage multiple priorities, and meet tight deadlines with minimal supervision
Nice-to-haves
ā¢ Masterās degree or Juris Doctorate preferred
ā¢ Certification in Health Care Compliance, Fraud Examination or Internal Audit is preferred
ā¢ Understanding of Maryland payment methodology and Health Services Cost Review Commission strongly preferred
ā¢ Ideal candidate will come from a health plan background and claims management experience is especially valuable
Benefits
ā¢ Johns Hopkins Health Plans is an organization that recognizes and rewards excellence and encourages professional development.
ā¢ Employee rewards, recognition, camaraderie and support are just a few of our many benefits include tuition assistance, dependent college tuition program, 403(b) retirement savings, health, dental vision and prescription coverage, disability and life insurance, paid time off and holidays.
Apply Now
Apply Now