Program Director Medicare Compliance

Johns Hopkins Medicine; Hanover (MD); Hybrid; USD 104,000 - 181,000; Full time

Job summary

Johns Hopkins Health Plans is seeking a Program Director - Medicare Compliance to lead the Medicare compliance program and ensure CMS and regulatory adherence. Responsibilities include guiding strategy, overseeing audits, and coordinating with internal teams and external partners to maintain a proactive compliance posture.

The role requires 5–7 years in Medicare compliance and 3–5 years of management, with strong HIPAA, CMS, and Maryland-related knowledge.

Qualifications

• Minimum 5-7 years in a Medicare Compliance program
• 3-5 years of management/supervisory experience
• Knowledge of CMS Medicare Advantage and Part D requirements
• Expert level HIPAA and related regulations
• Understanding Maryland payment methodology preferred
• Health plan or claims management background preferred

Responsibilities

• Lead Medicare compliance program and auditing efforts
• Oversee daily program operations and staff
• Develop compliance strategy and structure
• Collaborate across the organization and with FDRs
• Liaise with regulatory agencies
• Oversee corrective action and implementation of guidance

Skills

Medicare Compliance

CMS Regulations

HIPAA Knowledge

Project Management

Data Analysis

Communication Skills

Education

Bachelor's in Health Management or Business

Master's or JD preferred

Health Care Compliance certification preferred

Tools

Microsoft Office

Statistical Audit Tools

Job description

Job Details

• Requisition #: 673797


• Location: Johns Hopkins Health Plans, Hanover, MD 21076


• Category: Manager/Supervisor


• Schedule: Day Shift


• Employment Type: Full Time

This is a modified hybrid role: 1-2 days per week. Location is Hanover, MD.

The Johns Hopkins Health Plan is seeking a driven Program Director - Medicare Compliance to lead our Medicare compliance program and ensure full adherence to CMS and regulatory requirements. This role oversees daily program operations, guides compliance strategy 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 action and implementation of new guidance to maintain an effective, proactive compliance program.

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3.2B business serving nearly 500,000 members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider sponsored health plans-backed by the clinical expertise of Johns Hopkins Medicine and is poised for future growth.

Education/Certification

• Bachelor's degree in Health Management, Business or other applicable concentration


• Master's degree or Juris Doctorate preferred


• Certification in Health Care Compliance, Fraud Examination or Internal Audit is preferred

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 Act, OIG Compliance Guidelines, and other key regulations related to public health


• 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

This role requires strong critical thinking, strategic problemsolving, and the ability to communicate complex compliance requirements clearly. Candidates should excel in interpersonal communication, customer service, and collaboration across all organizational levels. Strong analytical ability, data interpretation skills, and project management capabilities-including planning, implementation, and reporting-are essential. Proficiency with Microsoft Office applications and statistical audit tools is required, along with the ability to research regulations, manage multiple priorities, and meet tight deadlines with minimal supervision.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered and have a passion to be at the forefront of change, JHHP is the place to call home.

What We Offer

Johns Hopkins Health Plans is an organization that recognizes and rewards excellence and encourages professional 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 vision and prescription coverage, disability and life insurance, paid time off and holidays.

Salary Range

Minimum 103,605.00/annually - Maximum 181,334.00/annually. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

Commitment to Inclusion

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.