Harris Health
Apply for the
Medicare Compliance Program Manager
position with
Harris Health . The role is based at Community Health Choice, Inc., a non‑profit managed care organization serving over 400,000 members through a range of health plans and services.
About Us Community Health Choice, Inc. (Community) is a non‑profit managed care organization licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs:
Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women
Children’s Health Insurance Program (CHIP), including CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
Health Insurance Marketplace Plans offering individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization for all, regardless of pre‑existing conditions
Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits such as dental, vision, and transportation
Improving members’ experiences is at the heart of every Community position. We strive every day to make sure that our members have access to the high‑quality health care they need and deserve. Community is accredited by URAC for its health plan operations and offers care management programs for asthma, diabetes, and high‑risk pregnancy. An affiliate of the Harris Health System, Community is financially self‑sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Job Summary The Medicare Compliance Program Manager leads and maintains Community Health Choice’s compliance program for Dual‑Eligible Special Needs Plans (D‑SNP). The role 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.
D‑SNP Compliance Monitoring & Oversight The Program Manager monitors all operational activities related to Medicare Advantage, Part D, D‑SNP, and Texas 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.
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.
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.
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.
Actively contributes to the achievement of departmental goals Actively contributes to the achievement of departmental goals, as identified in the Department’s annual business plan, including specific departmental process improvement plans, and other duties as assigned.
Qualifications
Education : Bachelor’s degree in healthcare administration, compliance, business, or related field; Master’s degree preferred.
Certification : Healthcare Compliance (CHC) or equivalent compliance credential.
Experience : 6+ years in healthcare compliance, including Medicare Advantage / Part D; at least 1–2 years directly involved with D‑SNP or dual programs.
Knowledge : Strong familiarity with CMS Medicare regulations, HPMS, state Medicaid/SMAC management.
Compliance Monitoring & Regulatory Implementation : Demonstrated experience with compliance monitoring, regulatory implementation, and attestation/reporting oversight.
Progressive Compliance Experience : 5–7 years progressive compliance experience with a Medicare health plan, with at least 2 years of experience with D‑SNPs preferred; direct experience with D‑SNP model of care, HIDE plans, and Medicare Program audits preferred.
Leadership & Management : 0–2 years of compliance management required; 2+ years of compliance management preferred.
Software & Tools : Microsoft Office Suite (Word, Excel, PowerPoint, Teams); regulatory / compliance tracking systems; data reporting and dashboard tools required; GRC tool implementation experience preferred.
Competencies : Analytical Thinking, Attention to Detail, Planning and Organizing, Critical Thinking.
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Medicare Compliance Program Manager
position with
Harris Health . The role is based at Community Health Choice, Inc., a non‑profit managed care organization serving over 400,000 members through a range of health plans and services.
About Us Community Health Choice, Inc. (Community) is a non‑profit managed care organization licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 members with the following programs:
Medicaid State of Texas Access Reform (STAR) program for low‑income children and pregnant women
Children’s Health Insurance Program (CHIP), including CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
Health Insurance Marketplace Plans offering individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization for all, regardless of pre‑existing conditions
Community Health Choice (HMO D‑SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits such as dental, vision, and transportation
Improving members’ experiences is at the heart of every Community position. We strive every day to make sure that our members have access to the high‑quality health care they need and deserve. Community is accredited by URAC for its health plan operations and offers care management programs for asthma, diabetes, and high‑risk pregnancy. An affiliate of the Harris Health System, Community is financially self‑sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Job Summary The Medicare Compliance Program Manager leads and maintains Community Health Choice’s compliance program for Dual‑Eligible Special Needs Plans (D‑SNP). The role 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.
D‑SNP Compliance Monitoring & Oversight The Program Manager monitors all operational activities related to Medicare Advantage, Part D, D‑SNP, and Texas 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.
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.
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.
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.
Actively contributes to the achievement of departmental goals Actively contributes to the achievement of departmental goals, as identified in the Department’s annual business plan, including specific departmental process improvement plans, and other duties as assigned.
Qualifications
Education : Bachelor’s degree in healthcare administration, compliance, business, or related field; Master’s degree preferred.
Certification : Healthcare Compliance (CHC) or equivalent compliance credential.
Experience : 6+ years in healthcare compliance, including Medicare Advantage / Part D; at least 1–2 years directly involved with D‑SNP or dual programs.
Knowledge : Strong familiarity with CMS Medicare regulations, HPMS, state Medicaid/SMAC management.
Compliance Monitoring & Regulatory Implementation : Demonstrated experience with compliance monitoring, regulatory implementation, and attestation/reporting oversight.
Progressive Compliance Experience : 5–7 years progressive compliance experience with a Medicare health plan, with at least 2 years of experience with D‑SNPs preferred; direct experience with D‑SNP model of care, HIDE plans, and Medicare Program audits preferred.
Leadership & Management : 0–2 years of compliance management required; 2+ years of compliance management preferred.
Software & Tools : Microsoft Office Suite (Word, Excel, PowerPoint, Teams); regulatory / compliance tracking systems; data reporting and dashboard tools required; GRC tool implementation experience preferred.
Competencies : Analytical Thinking, Attention to Detail, Planning and Organizing, Critical Thinking.
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