Compliance Program Manager, Provider Operations - Jefferson Health Plan

Health Partners Plans; Philadelphia (Philadelphia County); On-site; USD 90,000 - 140,000; Full time

Job summary

Health Partners Plans is seeking a Compliance Program Manager to oversee compliance across Medicare, Medicaid, CHIP, and ACA. You will align policies with regulations, manage internal and external audits, and drive corrective action plans while promoting accountability and efficiency across departments.

The role requires leading cross-functional teams, monitoring regulatory trends, and enhancing audit readiness.

Qualifications

• Bachelor's degree in a relevant field (Business Admin, Healthcare Admin, Public Health, Compliance, Risk Management, or related).
• 5 years of experience in compliance, auditing, risk management, or regulated healthcare operations.
• Experience coordinating internal and external audits.
• Strong analytical and written/verbal communication skills.
• Project and program management abilities to manage multiple initiatives.
• Audit and monitoring skills with data collection, analysis, reporting.
• Ability to develop and deliver compliance training.
• Strong interpersonal skills and cross-functional collaboration.
• Ability to interpret complex regulations; adapt to changing environments.
• Capacity to work independently and in fast-paced settings.

Responsibilities

• Track and maintain compliance activities across lines of business; support audits and regulatory deliverables.
• Review policies to ensure regulatory alignment.
• Conduct monitoring, auditing and implement action plans.
• Perform scheduled and ad-hoc regulatory audits.
• Lead root-cause analyses and manage corrective measures.
• Provide audit leadership and report findings to executives.
• Prepare teams for internal and external audits and ensure readiness.
• Serve as liaison for Compliance and Operations monthly meetings.
• Identify regulatory risks and drive improvement actions.
• Develop staff training on regulatory requirements.
• Standardize regulatory workflows to improve efficiency.
• Support regulatory reporting and performance initiatives.

Skills

Analytical thinking

Communication

Project management

Audit & monitoring

Training delivery

Conflict resolution

Attention to detail

Interpersonal skills

Leadership

Adaptability

Education

Bachelor's degree in Business Administration / Healthcare Administration / Public Health / Compliance / Risk Management

Job description

Number of Positions In Requisition 1

Job Details

The Compliance Program Manager is responsible for overseeing compliance activities across all lines of business, including Medicare, Medicaid, CHIP, and ACA. This role ensures policies and procedures align with requirements, manages internal and external audits, and leads the development of corrective action plans. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position also serves as a key liaison between Compliance and Operations teams, helping to maintain audit readiness and promote a culture of accountability and efficiency.

Summary

The Compliance Program Manager is responsible for overseeing compliance activities across all lines of business, including Medicare, Medicaid, CHIP, and ACA. This role ensures policies and procedures align with requirements, manages internal and external audits, and leads the development of corrective action plans. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position also serves as a key liaison between Compliance and Operations teams, helping to maintain audit readiness and promote a culture of accountability and efficiency.

Job Duties

• Ensure Regulatory Compliance: Track and maintain all compliance activities across all lines of business and work with units within the department to complete. Compliance activities include but are not limited to: External day-to-day inquiries, Internal/ External Audit Deliverables, Regulatory reporting
• Review department policies, procedures and desktop procedures to ensure they meet regulatory requirements.
• Conduct Monitoring, Auditing and Improvement Action Plan Activities within internal Teams: Conduct monitoring for all lines of business (Medicare, Medicaid, CHIP and ACA) according to departmental processes and workflows.
• Perform scheduled audits according to Compliance Work Plan
• Perform ad-hoc targeted regulatory audits as needed.
• Oversee the development, implementation and management of departmental improvement action plans initiated by internal and/or external audits by conducting root cause analysis, track progress, educate on audit errors and ensure timely completion of corrective measures.
• Audit & Meeting Management: Provide leadership in audits and reviews by regulatory bodies. Ensure accurate data collection and timely submission. Compile audit findings and report to executive management and internal committees as needed.
• Prepare assigned teams for internal and/or external regulatory audits by reviewing previous audit material and results and ensuring that department is ready and available to meet the needs of active and upcoming audits.
• Serve as the Compliance liaison for facilitating monthly Compliance team's meetings.
• Risk Mitigation: Research trends and identify areas that present potential risk to the departments.
• Utilize identified potential risks related to non-compliance to develop internal department improvement action plans to address deficiencies.
• Support Organizational Strategy: Assist in developing, producing, and conducting compliance training programs for staff to understand regulatory requirements.
• Improve Efficiency: Enhance operational efficiency by standardizing regulatory workflows.
• Support and deliver regulatory reporting and performance initiatives.

Minimum Qualifications

• Bachelor's Degree in a relevant field such as: Business Administration, Healthcare Administration, Public Health, Compliance, Risk Management, or a related field
• 5 years of experience in: Compliance, auditing, or risk management, Healthcare operations or a highly regulated industry, Managing or coordinating internal/external audits or Developing or overseeing compliance monitoring activities
• Strong analytical and critical thinking skills to assess compliance risks and identify solutions.
• Excellent written and verbal communication skills for clear reporting, training, and collaboration.
• Project and program management skills to organize, prioritize, and track multiple compliance initiatives.
• Audit and monitoring skills, including data collection, analysis, and reporting.
• Ability to develop, conduct, and deliver effective compliance training programs.
• Conflict resolution and negotiation skills.
• Attention to detail and accuracy in documentation and reporting.
• Strong interpersonal skills and ability to build relationships across departments and with external regulators.
• Ability to interpret and apply complex regulations and policies to business operations.
• Capacity to work independently and as part of a team in a fast-paced environment.
• Ability to lead cross-functional teams and manage multiple stakeholders.
• Skill in identifying compliance gaps and driving corrective action.
• Adaptability to changing regulatory environments and business needs.
• Strong organization