Program Manager at PEMCO overseeing product or program development and managing cross - functional teams to deliver strategic programs.
About the role
- Program Manager managing LTSS HEDIS and quality activities across Medicaid LTSS markets. Collaborating with stakeholders for compliance and quality reporting across various states.
Responsibilities
- Provide program management supporting LTSS HEDIS and quality activities across Medicaid LTSS markets
- Support end-to-end LTSS HEDIS operations, including data collection, validation, reporting, and audit readiness in alignment with contractual and regulatory requirements
- Support LTSS markets in maintaining compliance with NCQA LTSS Distinction standards and evolving CMS HCBS Quality Measure Set requirements under the Medicaid Access Final Rule
- Support LTSS HEDIS data logic, mapping, and measuring specifications, accounting for state-specific assessment tools, systems, and contractual nuances
- Partner with internal stakeholders and market teams to ensure accurate, timely, and compliant LTSS quality reporting aligning audit and performance teams across all participating states
- Support annual LTSS HEDIS audits, including review and oversight of member record reviews, IRR reviews, and overreads
- Support implementation and integration of new LTSS quality measures, assessing operational impact, data availability, validation requirements, and audit implications
- Identify risks related to compliance, data integrity, audit readiness, and operational capacity, and proactively develop mitigation strategies
- Drive process improvement, documentation, and standardization to improve consistency, efficiency, and quality outcomes across markets
- Provide backup coverage and business continuity for the LTSS COE Quality Program Director
- Develop and deliver training, guidance, and technical support to markets and internal teams on LTSS Quality requirements and best practices
- Monitor regulatory changes and emerging requirements to ensure the LTSS COE remains proactively compliant and audit-ready
- Support continuous quality improvement initiatives to strengthen quality performance, member surveys, state evaluations, and contract compliance
Requirements
- Requires a BA/BS
- minimum of 5 years external client facing experience in program/project management
- 5-7 years of LTSS experience (preferred)
- Experience conducting case management audits (preferred)
- Experience analyzing data and quality data reviews (preferred)
- Experience developing and implementing quality projects (such as PIPs or Quality Assessment and Process Improvement – QAPI) (preferred)
- Experience supporting LTSS Quality programs such as LTSS HEDIS, LTSS Distinction and CMS LTSS Quality Measures preferred
- Medicaid HEDIS and Medicare Stars knowledge/experience (preferred)
- Six Sigma Certification (preferred)
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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