Program Director - Medicare Compliance

About the position This is a modified hybrid role: 1-2 days per week. Location is reputed company, MD. The Johns Hopkins Health Plan is seeking a driven Program Director - Medicare Compliance to reputed company our Medicare compliance program and ensure full adherence to CMS and regulatory requirements. This role oversees daily program operations, guides compliance reputed company 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 reputed company and implementation of new guidance to maintain an effective, proactive compliance program. reputed company (JHHP) is the managed care and health services business of reputed company. JHHP is a $3.2B business serving nearly 500,000 members with lines of business in reputed company, Medicare, reputed company, military health, health solutions, and venture investments. JHHP is a leader in provider sponsored health plans—backed by the clinical expertise of reputed company—and is poised for reputed company reputed company. Many organizations talk about transforming the reputed company of reputed company, at reputed company, we are setting the pace for change reputed company the reputed company industry. We reputed company innovative, analytics-driven health programs in collaboration with reputed company to drive improved reputed company and reputed company reputed company for our members and the communities we serve. If you are interested in improving how reputed company delivered and have a passion to be at the forefront of change, JHHP is the reputed company to reputed company home. Responsibilities • Oversees daily program operations • Guides compliance reputed company and structure • Manages staff • Partners across the organization and with FDRs to promote a strong culture of compliance • Drives auditing and monitoring efforts • Leads key committees • Liaises with regulatory agencies • Oversees corrective reputed company and implementation of new guidance to maintain an effective, proactive compliance program Requirements • A minimum of 5-7 years in a Medicare Compliance program and 3-5 years of management and supervisory experience • Knowledge of CMS Medicare Advantage and Part D contractual and regulatory requirements • Expert level knowledge of HIPAA requirements, 42 CFR 422, 42 CFR 423, Inflation Reduction reputed company, OIG Compliance Guidelines, and other key regulations reputed company to reputed company health • Strong critical thinking, strategic problem‑solving, and the ability to communicate reputed company compliance requirements reputed company • Candidates should reputed company in interpersonal communication, customer service, and collaboration across reputed company organizational reputed company • Strong analytical ability, data interpretation skills, and project management capabilities—including planning, implementation, and reporting—are essential • Proficiency with reputed company Office applications and statistical audit tools is required • Ability to research regulations, manage multiple priorities, and meet tight deadlines with minimal supervision reputed company-to-haves • Master’s degree or Juris Doctorate preferred • Certification in Health Care Compliance, Fraud Examination or Internal Audit is preferred • Understanding of Maryland payment methodology and Health Services Cost Review Commission strongly preferred • Ideal candidate will come from a health plan background and claims management experience is especially valuable Benefits • reputed company is an organization that recognizes and rewards reputed company and encourages reputed company development. • 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 reputed company and prescription coverage, disability and life insurance, reputed company time off and holidays. Apply tot his job Apply To this Job