Senior Dual Compliance Program Manager

Site: Mass General Brigham Health Plan Holding Company, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the worlds 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 welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

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

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.

Essential Functions

• 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 organizations activities, data, and operations to identify areas of non-compliance or potential risks.
• Prepare and submit compliance reports to the Medicare Compliance Officer, 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.
• Analyze data to identify trends and patterns related to compliance. Use data to proactively address potential issues.

Qualifications

Education

• Bachelor's Degree required

Experience

• At least 5-7 years of experience in health plan compliance, with a focus on Medicare (DSNP and/or Medicare Advantage) regulations required
• DSNP compliance experience highly preferred

Knowledge, Skills, and Abilities

• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Current in healthcare trends.

Additional Job Details (if applicable)

Working Conditions:

• This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville roughly 2- 3x/month

Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$99,465.60 - $141,804.00/Annual

Grade

8

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.