Health Plan Administration Contract Manager, Operations

MassHealth is Massachusetts's Medicaid and Children's Health Insurance Program (CHIP). MassHealth provides comprehensive, affordable health care coverage for over two million low-income Massachusetts residents, including 40% of all Massachusetts children and 60% of all residents with disabilities. MassHealth's mission is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainably and equitably promote health, well-being, independence, and quality of life.

The Health Plan Administration and Oversight (HPAO) team is part of the Office of Payment and Care Delivery Innovation (PCDI) and is tasked with the oversight and management of MassHealth's Accountable Care Organizations (ACOs), Managed Care Organization (MCOs), and Primary Care Clinician (PCC) Plan. The ACOs, MCOs, and PCC Plan are responsible for delivering services to ~1.5 million MassHealth members and are key partners in improving health care outcomes and driving innovation. 

ACOs are the central managed care delivery system of MassHealth's current 1115 Demonstration, which has been a critical tool in enabling Massachusetts to achieve and maintain near-universal health coverage, sustain the Commonwealth's safety net health system, expand critical behavioral health services, and implement reforms in the way that care is delivered. MassHealth ACOs initially launched in 2018 and 17 new ACOs were launched in 2023. ACOs are provider-led managed care organizations accountable for improving quality of care, member experience, and total cost of care. Since 2018, ACOs have transitioned care for over a million members from a largely fee-for-service system towards a value-based payment model where providers are accountable for managing the health of their membership. 

The Health Plan Administration Contract Manager, Operations will drive towards improved healthcare outcomes for members, robust and high-quality service delivery and streamlined administrative processes by managing internal and external system-related processes on behalf of the Health Plan Administration and Oversight team. The incumbent will research specific issues to identify trends (such as issues with member enrollments and plan payments) and will be expected to execute key initiatives related to contract compliance and performance improvement. The incumbent will work alongside the Health PlanContract Managers and staff from other MassHealth offices, such as System Operations, Eligibility Implementation, Enrollment Operations, the Office of Behavioral Health (OBH), the Office of Long Term Services and Supports (OLTSS), the Pharmacy Office, and others, in order to implement new initiatives to improve plan performance, gather information about current initiatives and present findings to PCDI and MassHealth Leadership. 

The Health Plan Administration Contract Manager, Operations will be expected to support multiple efforts in a fast-paced, cross-functional work environment, and coordinate workstreams across multiple teams throughout PCDI and the agency.They will need to have a working understanding of how IT systems operate in the healthcare space, be passionate about driving change in health care for underserved populations, have strong project management skills and experience, be attentive to detail and have excellent communication skills.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Manage internal and external system related processes. 
  • Collaborate with staff across MassHealth to understand key data flows related to the ACOs, MCOs, and the PCC Plan as well as their downstream impacts and importance to plan performance.  
  • Communicate expectations and timeline to the ACOs and MCOs when a new process is being rolled out or when an improvement is being implemented and serve as the key point of contact for follow up questions.  
  • Track progress towards goals, communicate risks and issues to the Deputy Director of Health Plan Operations and summarize results for leadership. 
• Assist with ad-hoc data requests and researching complex issues within the MassHealth data systems.
  • Understand the MassHealth technology infrastructure and coordinate the collection of data with other technical subject matter experts throughout the agency. 
  • Gather information from internal teams, ACOs, and MCOs, to provide insight on key program questions and present the information in a distilled, easy-to-understand fashion.  
  • Serve as the key point of contact for technology and data related questions.  
• Execute and coordinate activities related to key changes to current programs, as well as new initiatives.  
  • Collaborate with PCDI and staff across the agency to develop work plans to implement upcoming changes and report on progress. 
  • Assist subject matter experts throughout PCDI in the implementation of the changes, including completing review of the information being changed to ensure accuracy.
• Manage the maintenance of key internal documentation related to system processes, 
  • Develop an understanding of key documents across the ACO, MCO, and PCC Plan programs,  
  • Regularly review documentation with PCDI and other agency staff to identify updates,  
  • Collaborate with MassHealth Publications to update documents in a timely manner and distribute the information to all impacted stakeholders. 

Preferred Qualifications:                                                      

• Passion for public service.
• Excellent analytical and problem-solving skills.
• Excellent skills utilizing Microsoft Office Suite, especially Word, Excel and PowerPoint.
• Experience using Adobe suite a plus.
• Excellent organizational skills and attention to detail.
• Ability to parse complicated problems with minimal direction, and clearly communicate findings to a variety of stakeholders (internal and external).
• Ability to lead projects through organizing work, establishing operating relationships, and coordinating the work of others.
• Ability to analyze and determine the applicability data, to draw conclusions, and to make appropriate recommendations.
• Strong communication skills.
• Strong interpersonal skills.
• Experience in healthcare.
• 2-4years' experience working in analytical capacity.
• Enjoy working in high paced environment, often including tight time constraints.

TO APPLY:

Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.

About MassHealth:

The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.

For more information about our agency and programs please visit: www.mass.gov/masshealth

Pre-Offer Process:

A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori

Education, licensure, and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.

Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.

If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form.

For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.

MINIMUM ENTRANCE REQUIREMENTS:

Applicants must have at least (A) four (4) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below.

Substitutions:

I. A certificate in a relevant or related field may be substituted for one (1) year of the required experience.

II. An Associate's degree in a related field may be substituted for one (1) year of the required experience.

III. A Bachelor's degree in a related field may be substituted for two (2) years of the required experience.

IV. A Graduate degree in a related field may be substituted for three (3) years of the required experience.

V. A Doctorate degree in a related field may be substituted for the required experience.

Comprehensive Benefits

When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.

Want the specifics? Explore our Employee Benefits and Rewards!

An Equal Opportunity / Affirmative Action Employer.  Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.

The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law.  Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements.  We encourage individuals who believe they have the skills necessary to thrive to apply for this role.