Program Director, Key Vendor Operations - Mass General Brigham Health Plan

Program Director, Key Vendor Operations - Mass General Brigham Health Plan

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Director, Key Vendor Operations is accountable for effective and accurate implementation of core business processes in vendor systems, working closely with key teams including Clinical Behavioral Health, IT, Line of Business leadership, to inform and monitor the execution of contractual requirements. This work includes daily interactions with MGBHP’s Behavioral Health vendor, a select limited BH service vendor, and other vendors as designated by the COO. Our work to support our provider experience is a critical component of the service excellence we provide to our members.

Principal Duties and Responsibilities:

Ensure operational components of the Behavioral Health vendor relationship are fully supported through documented business process, including but not limited to claims processing, provider payment for the Medicaid line of business, Medicare Advantage and Commercial coverage and member cost sharing.

Monitor compliance with federal and state regulatory requirements that impact Key Vendors including but not limited to the Behavioral Health vendor.

Coordinate monitoring activities with key QNXT business owners to ensure appropriate application of business rules across separate claims systems.

Support Customer Service in escalated case review as requested, lending expert input re: expected claims outcomes on an individual case basis.

Provide quarterly updates to the Behavioral Health Operations Committee to summarize the change requests submitted to the Behavioral Health vendor by line of business.

Utilize analytical tools, including Power Bi, Share Point, automated flows, to ensure effective and accurate implementation of benefit coverage and Medicaid rates in the Behavioral Health vendor’s systems.

Collaborate with IT and Product leads (Medicare Advantage, Commercial or Mass Health) to ensure success of key corporate initiatives including specialized vendor offerings (virtual first behavioral health care).

Support the Director, Clinical Behavioral Health in trade organization follow up on key operational topics including rates, claims processing.

• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications:

• Bachelor’s degree required or the equivalent combination of training and experience, plus 5-7 years of related experience.
• Master’s degree preferred.

Skills/Abilities/Competencies:

• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.”
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the “big picture.”
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

• Motivates and encourages a staff; leads through change and adversity. Makes decisions as needed and builds consensus as appropriate. Communicates and cascades information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.
• Sets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Provides coaching to improve performance and holds regular development discussions with direct reports. Recognizes staff for their contributions.
• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve—our members, providers, brokers, and employers—front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.