Program Manager - Regulatory Programs

SSM Health   •  

Madison, WI

Industry: Healthcare


Not Specified years

Posted 56 days ago

This job is no longer available.

Role Purpose:

The core responsibility of this highly visible position is the overall management the organization’s performance under the Medicare Access & CHIP Reauthorization Act (MACRA). This includes the organization’s participation in the Merit-Based Incentive Payment System (MIPS) track with a goal of successfully transitioning to the risk-based Alternative Payment Model (APM) track. The incumbent is responsible for overall compliance with federal requirements, responding to any Centers for Medicare and Medicaid Services (CMS) audits, leading the Regional MACRA Steering team, organizational strategy and education, and regular communication with leadership. In addition, this position will manage and coordinate the activities of the Clinical Documentation Specialist (CDS) team within an environment of continuous quality and process improvement. The CDS team is primarily responsible for helping to maintain current, accurate, and specific patient Problem Lists in the electronic health record.


1. Serve as the Wisconsin region’s MACRA subject matter expert (SME); provide ongoing education, serve as primary point of contact for System, etc.

2. Maintain accurate and complete database of CMS-defined eligible clinicians

3. Develop and present formal presentations on progress, justifications, and details to oversight committees, sponsors, and leadership.

4. Working with sponsors and leadership, create and manage the MACRA Project Plan for DMG including scope, schedule, budget, communication, risk management, etc.

5. Manages the daily operations of the CDS team including the hiring, training, and performance management of staff.

6. Analyzes, updates, and modifies procedures and processes in order to continually improve efficiency.

7. Conducts regular staff meetings

8. Conducts internal auditing of the work of staff regularly; outlining clear expectations for staff related to both quantity and quality or work.

9. Develops, implements, and maintains documentation of all workflows for all key work processes.

10. Work with management to acquire resources for projects (team members) and ensure tasks are assigned to appropriately skilled resources.

11. Identify and resolve dependencies and constraints by working with sponsors and leadership.

12. Respond to all CMS audits in a timely, accurate, and comprehensive manner

13. Facilitate the implementation of workflow changes in order to maximize the organization’s financial performance under MACRA

14. Monitor changes to MACRA legislation; respond to and implement any necessary organizational changes

15. Ongoing monitoring of all clinical and financial metrics related to MACRA

16. May be asked to participate in strategy formation relative to other value-based payment arrangements that impact DMG reimbursement

17. Other duties as assigned.


1. Bachelor’s degree with at least 5 years of experience in a healthcare organization

2. Demonstrated experience with quality improvement tools and methodologies

3. Previous project/program management experience

4. Demonstrated ability to function at a high level in a dynamic work environment.

5. The ability to meet deadlines and work under pressure while providing a positive image

6. Strong leadership skills

7. Excellent organizational skills and the ability to work within all levels of the organization

8. Excellent written and oral communication skills.

9. Strong analytical, problem solving, facilitation, and interpersonal skills.

10. Experience with change management and act as subject matter expert (SME) for courses of action and influence key stakeholders


1. Previous experience with CMS provider incentive programs such as Meaningful Use, Physician Quality Reporting System (PQRS), MIPS, APM, bundled payments, etc.

2. Previous experience with the Epic (electronic health record software)

3. Previous experience with risk-based alternative payment models such as an accountable care organization (ACO), Shared Savings Program, Comprehensive Primary Care Plus (CPC+), bundled payments, etc. and hierarchical condition category (HCC) coding

4. Previous supervisory experience

5. Experience with implementing change within an healthcare organization

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. This is a predominately office setting environment.

2. Ability to sit for extended periods while on the phone or computer.

3. Ability to continuously see fine print and to use the computer for extended periods.

4. Ability to perform fine motor tasks, such as computer, writing or phone tasks.

5. Ability to hear and converse on the phone and in person.

6. Ability to safely drive a personal vehicle at least weekly and comply with the Company’s Fleet/Driver Safety Program.