Senior Dual Compliance Program Manager

This is a hybrid role requiring a regular onsite office presence every month at Assembly Row, Somerville.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Senior Duals Compliance Program Manager is responsible for ensuring that the organization's programs and services for dual-eligible beneficiaries (those eligible for both Medicare and Medicaid) comply with all relevant regulations, laws, and industry standards. This role is responsible for overseeing, implementing, and monitoring the organization's compliance with federal and state regulations related to the Medicare and Medicaid programs. This role involves developing and implementing compliance policies, monitoring operations, and collaborating with various stakeholders to uphold ethical and legal standards as well as collaborating with the Medicare Compliance Officer and Internal Audit team regarding audits and assessments to ensure adherence to regulations. The Senior Duals Compliance Program Manager collaborates with their Medicare Compliance colleagues to prevent compliance breaches, identifies potential issues, and takes corrective actions when necessary.

Principal Duties and Responsibilities:

* Leveraging the existing Medicare and Medicaid compliance program tools, further develop, implement, and maintain a comprehensive compliance program specific to the dual-eligible population, incorporating both Medicare and Medicaid requirements.
* Stay current with all regulations, guidelines, and changes in Medicare and Medicaid related to dual-eligible beneficiaries.
* Develop, review, and revise compliance policies, procedures, and protocols, ensuring alignment with federal and state regulations.
* Work with Learning and Development to provide training and educational programs to staff and stakeholders on compliance requirements, standards, and best practices.
* Regularly assess the organization's activities, data, and operations to identify areas of non-compliance or potential risks.
* Prepare and submit compliance reports to the Medicare Compliance Officer and senior management and relevant regulatory bodies as required. Communicate findings and make recommendations for corrective actions.
* Lead or assist in internal investigations related to compliance issues, including duals-specific concerns. Collaborate with legal and HR teams when necessary.
* Work closely with cross-functional teams, including clinical, administrative, and finance departments, to ensure compliance in all aspects of dual-eligible care delivery.
* Analyze data to identify trends and patterns related to compliance. Use data to proactively address potential issues.
* Hold self and others accountable to meet commitments.
* Ensure diversity, equity, and inclusion are integrated as a guiding principle.
* Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
* Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
* Other duties as assigned with or without accommodation.

Qualifications:

* Bachelor's degree required or the equivalent combination of training and experience, plus 5-7 years of related healthcare experience.
* Extensive knowledge of Medicare and Medicaid regulations and compliance requirements.
* Master's degree preferred.
* Project Management experience a plus.

Skills/Abilities/Competencies:

* Strong analytical and problem-solving skills.
* Excellent communication and interpersonal skills.
* Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
* Bring fresh ideas forward by listening to and working with employees and the people we serve.
* Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
* Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
* Strong aptitude for technology-based solutions.
* Ability to inject energy, when and where it's needed.
* Current in healthcare trends.
* Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."
* Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
* Excellent leadership skills and leadership track record.
* Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
* Ability to view the long-range trends and cycles of the business and industry and see the "big picture."
* Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
* Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
* Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
* Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
* Unquestionable integrity.

Fiscal Responsibility:

* No direct budgetary responsibility
* Demonstrates fiscal responsibility by effectively using Mass General Brigham Health Plan resources

Working Conditions:

* Normal office working conditions.
* Hybrid position.

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.