Manager, Program Management

About the role

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We've had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it's at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health . Job Summary The SCO Care Management program has grown and will continue to grow, in membership, regulatory complexity, and operational scope, exceeding the capacity of existing clinical management structures. While Clinical Managers focus on frontline execution, there is no centralized accountability for program performance, regulatory readiness, audit response, and cross product alignment across SCO and D SNP programs. A dedicated Program Performance Manager will serve as the single point of accountability for SCO Model of Care integrity, audit coordination, MDS HC/UCA quality oversight, performance reporting, and continuous improvement. Under direction of the Director, manages programs and projects with significant complexity, risk and/or cost related to compliance and quality as well as manages 3 or more direct reports. Initial key responsibilities will include: Regulatory & Compliance Leadership - Serve as the SCO Care Management regulatory and contract subject matter expert - Own audit readiness and response for State, CMS, and internal monitoring - Translate Model of Care and regulatory requirements into operational workflows, training, and documentation standards - Ensure alignment of policies and procedures with evolving regulations (e.g., UCA, eCAS, CTD→MHK) Program Performance & Quality Oversight - Own and monitor program level KPIs (Stars, HEDIS, utilization, transitions of care, MDS performance) - Lead cross functional performance improvement initiatives - Ensure Care Management readiness for new system launches and regulatory changes Strategic Enablement & Sustainability - Act as the primary liaison between Care Management, Product, Population Health, Compliance, and IT - Maintain centralized governance for policies, training content, and regulatory guidance - Ensure continuity and sustainability of improvements post implementation Job Description Overall program ownership and management of key programs, focusing on both short-term initiatives and long-term strategic direction and objectives for the programs. Development, implementation, and oversight of the Program including but not limited to leading interpretation and implementation of new regulatory guidance and prepare, providing consultation to staff on compliance issues and processes and coordinating responses for all internal and external activities across LOBs. Oversees all activities and responsibilities of the quality team including but not limited to Manages the design/development, implementation, evaluation, and report writing of quality improvement programs and projects Collaborates with business partners to conduct secondary research and to design and implement qualitative and quantitative analysis as needed. Formulates findings, draws conclusions, makes recommendations for action and works with stakeholders to document the findings and reports based on the data. Responsible for the timely completion of all activities and final deliverables that meet requirements for the QI programs. Leads the major Program for the department and organization including collaborating with colleagues across the organization, participating as a member of organization Parity Core team, leading the implementation of organization wide parity champion program. Leads regular cross functional informational or working meetings, including effective agenda planning, facilitation, and tracking/follow up on deliverables until closed. Meetings include, but not limited to, Business Stakeholders and Operations Working team. Other duties and projects as assigned. EDUCATION, CERTIFICATION AND LICENSURE: Bachelor's Degree required Master's degree preferred PMP Certification preferred. PMP eligibility required. EXPERIENCE (minimum years required) : 8-10 years' business or industry experience. 5-8 years of program management experience, including leading significant cross-functional, high-level initiatives. SKILL REQUIREMENTS: Using knowledge of company, able to resolve most roa

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