Manager, Program Management

Who We Are

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Health is a leading not-for-profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare. Serving nearly 2 million members, we build 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 community of care and shared values that guide our behaviors and decisions.

The SCO Care Management program is expanding in membership, regulatory complexity, and operational scope. A 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. This role reports to the Director and manages software, initiatives, and 3 or more direct reports.

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.

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.

• Overall program ownership and management of key programs, focusing on short‑term initiatives and long‑term strategic direction.
• Development, implementation, and oversight of programs, including
  • Leading interpretation and implementation of new regulatory guidance and preparation.
  • Providing consultation to staff on compliance issues and processes.
  • Coordinating responses for all internal and external activities across LOBs.
• Oversee all activities and responsibilities of the quality team, including
  • Design, development, implementation, evaluation, and report writing for quality improvement programs.
  • Collaboration with business partners to conduct research and analysis, formulate findings, and make recommendations.
  • Ensure timely completion of all deliverables that meet QI program requirements.
  • Lead the major program for the department and organization, including collaboration across the organization.
  • Lead regular cross‑functional informational or working meetings, including agenda planning, facilitation, and follow‑up.
  • Other duties and projects as assigned.

• Bachelor’s Degree required.
• Master’s degree preferred.
• PMP Certification preferred. PMP eligibility required.

• 8–10 years of business or industry experience.
• 5–8 years of program management experience, including leading significant cross‑functional, high‑level initiatives.

• Resolve program roadblocks, coordinate internal contacts, and maintain program momentum.
• Navigate political and organizational challenges, advocate for programs, and negotiate involvement.
• Identify and manage conflicts, risks, and integration issues, and estimate resources accurately.
• Possess detailed content knowledge of the specific program and advanced training in the field.
• Excel in communication, relationship management, and facilitation, including difficult group dynamics and stakeholder influence.
• Lead and mentor a team of program managers, fostering collaboration and high performance.
• Present technical information clearly and persuasively to senior management and external contacts.
• Champion change, conceptualize impact, and propose innovative business solutions.
• Maintain effective peer relationships and motivate colleagues through teamwork and cooperation.
• Demonstrate strong influencing…