Janice M Peters
Somerville,MA
Summary
Results oriented compliance professional, passionate in creating effective and transparent strategies for ensuring a successful compliance audit and investigation program. Skilled in regulatory analysis and implementation, professional communication across all levels of the organization, and working closely with leadership to balance multiple priorities in a fast-paced constantly changing, heavily regulated environment.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Manager, Quality & Compliance
Point32Health
06.2022 - Current
- Analyze and provide operational guidance on legislative, regulatory, and contractual requirements from CMS, Multi-State Regulators (i.e. DOI, EOHHS, OHIC), and the National Committee for Quality Assurance (NCQA).
- Oversee development, management and maintenance of department policies and procedures that are compliant with all state, federal, and accreditation requirements.
- Partner with compliance, legal, and department leadership to identify and categorize risk, develop remediation steps, and track business decisions regarding corrective actions or risk acceptance.
- Manage and mentor Compliance and Quality program managers who support and project manage HEDIS, NCQA, and compliance interventions and standards for the department.
Compliance Program Manager II -III
Tufts Health Plan
06.2019 - 06.2022
- Oversaw the successful completion of 10+ federal and state audits. Deliverables included management of materials used as evidence of compliance, preparing staff for audit sessions, and developing and tracking corrective action plans or other remediation efforts required.
- Conducted monthly monitoring of high-risk procedures, summarizing results and communicating compliance gaps, risks, and remediation recommendations.
- Researched and investigated compliance inquiries or potential issues identified through day-to-day operations and audit oversight activities.
Manager, Healthcare Policy
Massachusetts Health & Hospital Association
05.2016 - 06.2019
- Provided education, training, and operational guidance to hospital leadership on critical state and federal regulations, such as hospital licensure and sterile compounding regulations, from DPH, DMH, Board of Pharmacy, and EOHHS.
- Lead multi-stakeholder provider/payer workgroup that initiated the framework for what became the Expedited Psychiatric Inpatient Admission (EPIA) policy co-sponsored by DOI, DPH, and DMH.
- Secured DSRIP funding and coordinated Event Notification System (ENS) implementation with key stakeholders across Emergency Departments and payers across MA.
- Built and delivered training for nurses across all MA hospitals on procedures associated with sexual assault cases presenting in emergency departments in partnership with the DPH Sexual Assault Nurse Examiner (SANE) Program.
Project Lead, Training & Communications
Fallon Health
11.2011 - 07.2014
- Executed development and delivery of comprehensive training needs of department, ensuring they met federal and state regulatory requirements.
- Chosen by leadership to represent dept in Marketing Strategy, Regulatory, and Affordable Care Act implementation sub-committees.
Lead, Urgent Team
Fallon Health
10.2010 - 11.2011
- Provided skill-based development and leadership for team of 10 staff.
- Lead root cause analysis and issue resolution for member experience improvements in pharmacy and Medical UM benefits in collaboration with cross-department and executive leadership.
- Developed and launched a first of its kind "concierge" service model to respond to high priority and retention issues from key business partners.
Education
Masters Public Health - Health Policy & Management
Boston University
Boston, MA06.2016
Bachelor of Arts - Psychology
University of Massachusetts Boston
Boston, MA01.2010
Skills
- Program Management
- Training strategy and Delivery
- Strategic Planning
- Critical thinking
- Resiliency
- Operations management
- Team leadership
- Decision-making
Certification
Certification Healthcare Compliance - Health Care Compliance Association (In Progress)
Timeline
Manager, Quality & Compliance
Point32Health
06.2022 - Current
Compliance Program Manager II -III
Tufts Health Plan
06.2019 - 06.2022
Manager, Healthcare Policy
Massachusetts Health & Hospital Association
05.2016 - 06.2019
Project Lead, Training & Communications
Fallon Health
11.2011 - 07.2014
Lead, Urgent Team
Fallon Health
10.2010 - 11.2011
Masters Public Health - Health Policy & Management
Boston University
Bachelor of Arts - Psychology
University of Massachusetts Boston
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