JOB SUMMARY

The Medicare Compliance Program Manager leads and maintains CHC’s compliance program for Dual-Eligible Special Needs Plans (D-SNP). This position ensures adherence to Medicare Advantage Part C & D, D-SNP, and State Medicaid Agency Contract (SMAC) requirements

through proactive monitoring, regulatory interpretation, and collaboration across functional areas. The Program Manager manages HPMS notices and Medicare Final Rules, validates implementation of regulatory changes, oversees required reporting and attestations, and

serves as the compliance subject matter expert for D-SNP operations. The role partners closely with legal, operations, and regulatory stakeholders to maintain alignment with CMS and state requirements.

JOB SPECIFICATIONS AND CORE COMPETENCIES

30% D-SNP Compliance Monitoring & Oversight The Program Manager monitors all operational activities related to Medicare Advantage, Part D, D-SNP, and TX HHSC SMAC requirements.

This includes evaluating performance against regulatory benchmarks, identifying risks and trends, and collaborating with operational teams to implement corrective action plans.

The role maintains compliance dashboards and metrics, escalates issues as appropriate, and reviews member-facing materials and communications to ensure consistency with CMS and SMAC requirements.

30% HPMS Notices & Regulatory Guidance Management This role monitors, reviews, and distributes HPMS memos, Final Rules, and other regulatory guidance impacting D-SNP operations.

The Program Manager develops and shares internal guidance to ensure stakeholders understand changes and validates that all mandated updates are incorporated into policies, procedures, systems, and training programs.

20% Attestation, Reporting, and State/SMAC Contract Oversight The Program Manager oversees the preparation, coordination, and submission of all required attestations to CMS and Texas HHSC for D-SNP plans.

This responsibility includes managing timely and accurate reporting such as Part C & D reporting, PDE submissions, and other SMAC deliverables. The role ensures compliance with state level regulatory requirements and coordinates updates related to the State Medicaid Agency Contract.

15% Organizational Compliance Strategy & Stakeholder Collaboration the Program Manager contributes to the annual Medicare/D-SNP compliance work plan by tracking progress and reporting outcomes.

The role serves as a compliance subject matter expert across CHC, providing guidance to operations, product development, and marketing on D-SNP requirements. Additionally, the Program Manager supports new business and contract implementations, including review of

SMAC obligations and unique state-level rules. 5% Actively contributes to the achievement of departmental goals, as identified in theDepartment’s annual business plan, including specific departmental process improvement plans, and other duties as assigned.

QUALIFICATIONS:

Required

Bachelor’s degree in healthcare administration, Compliance, Business, or related field, or equivalent combination of education and relevant experience.

6 years of experience in healthcare compliance, including Medicare Advantage / Part D; at least 1-2 years directly involved with D-SNP or duals programs.

Strong knowledge of CMS Medicare regulations, HPMS, State Medicaid/SMAC management.

Demonstrated experience with compliance monitoring, regulatory implementation,

attestation/reporting oversight.

0-2 years of compliance management

Microsoft Office Suite (Word, Excel, PowerPoint, Teams) Regulatory / compliance tracking

systems Data reporting and dashboard tools

Preferred

Master’s in Healthcare Administration, Public Health, Business, or related field

Certification in Healthcare Compliance (CHC) or equivalent compliance credential.

5-7 years of progressive compliance experience with a Medicare health plan, with at

least 2 years’ experience with D-SNPs.

Direct experience with D-SNP model of care, HIDE plans and Medicare Program audits.

Prior responsibility with leading Medicare compliance program oversight.

2 or more years of compliance management

Experience implementing a regulatory compliance tracking system (GRC tool).

Job Type: Full-time

Pay: $92,800.00 – $116,000.00 per year

Work Location: Hybrid remote in Houston, TX 77081