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Location

Boston, MA | United States

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Job description

MassHealth’s Integrated Care team reports directly to the Chief of Long-Term Services and Supports and is responsible for MassHealth’s integrated care delivery systems: One Care, Program of All-inclusive Care for the Elderly (PACE) Organizations, and Senior Care Options (SCO), including for individuals eligible for Medicare and Medicaid (dual eligibles).

The Integrated Care Operations Manager reports to the Special Projects and Operations Manager and provides support to the Integrated Care team by providing operational and organizational expertise and advancing implementation of new policy or programmatic initiatives. The Integrated Care Operations Manager will assist with creating, manipulating and disseminating several recurring reports with Integrated Care stakeholders to track and maintain Integrated Care Operations. The Integrated Care Operations Manager will participate in and help execute operational projects to support new and ongoing Integrated Care program operations. The Integrated Care Operations Manager will participate in cross-agency efforts and workgroups impacting One Care, PACE, and SCO, and will lead and support operational changes necessary to support policy or program changes, operational and business interfaces, and enrollment and eligibility related implementations and changes. As requested, the Integrated Care Operations Manager will suggest and implement internal process improvements with an eye towards practical, streamlined solutions.

Individuals with diverse backgrounds or who demonstrate cultural competency working with the diverse populations enrolled in MassHealth are encouraged to apply.

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

Coordinate Integrated Care Internal Operations and Implementations

• Coordinate projects in multiple areas; planning, implementing, overseeing coordination between individuals and departments throughout the duration of projects.
• Participate in and contribute to complex and cross-agency projects and workgroups as assigned for new state and federal requirements, operational changes necessary to support policy or program changes, and enrollment and eligibility practice changes.
• Support the Special Projects and Operations Manager, Integrated Care Program Managers and Contract Managers by facilitating cross-cutting program communications, collecting, compiling, and documenting processes and information.
• Serve as a subject matter expert (SME) and liaison for enrollment, eligibility, and integrated care/managed care operations issues.
• Represent the Integrated Care team on internal and multi-agency workgroups as needed.
• Document and organize operational policies and procedures for Integrated Care team and MassHealth reference and to support implementation of changes.
• Develop and maintain productive, collaborative relationships with peers and counterparts on other managed care teams, as well as others in MassHealth, at other state agencies, and at CMS.
• Lead or participate in special projects and work groups to promote operational efficiencies that will lead to better experience for members and providers engaged in integrated care programs.
• Recommend and implement management strategies for operations and implementation projects and escalate issues appropriately within MassHealth and to CMS.
• Participate in training and technical assistance to deepen knowledge, expertise, and skills related to program operations and intricacies of implementing both Medicare and Medicaid programs through integrated health plans.

Manage and Resolve Eligibility and Enrollment Issues

• Serve as an Integrated Care team liaison to the MassHealth Enrollment Operations and Eligibility teams.
• Coordinate or handle the research of answers and issue resolution related to enrollment and eligibility issues.
• Problem-solve, recommend policy and program changes, and manage implementation of enrollment and eligibility resolutions and updates.
• Review, analyze, and interpret data from a variety of sources; recommend and apply findings to policy and procedure change processes and implementations.
• Prepare and maintain various operational reports and be responsible for disseminating reports to internal and external stakeholders in accordance with program reporting calendar.

Manage Plan-facing Operational, IT, and Business Process Issues

• Propose and implement continuous improvements and program operations efficiencies for One Care, SCO, and PACE.
• Participate in periodic audit and review processes to ensure proper Plan implementation and management of contract requirements and agency processes.
• Understands MassHealth’s operational interactions with Integrated Care Plans and recommend improvements.
• Assist Special Projects and Operations Manager in drafting business procedure documents describing operational changes for integrated care plans.
• Manage and facilitate resolution of plan operational and IT questions and concerns.
• Document and organize operational policies and procedures for Plan-facing implementation.
• Develop and maintain productive relationships with integrated care plan operations and IT contacts, and provide technical support and assistance as needed to plans.
• Conduct or participate in training and outreach sessions for Integrated Care Plans as needed.
• Maintain open lines of communication with internal, external, and interagency stakeholders to ensure ongoing collaboration, coordination, and input.
• Perform other duties as required.

Required Qualifications:

• Ability to set goals and strive for excellence or improvement.
• At least 2 years of experience with project coordination and/or project management
• Passion for public service
• Ability to identify a problem or opportunity and take action to address current or future problems and opportunities.
• Ability to think through problems, organize information, and identify key factors and underlying causes to generate solutions.
• Ability to work cooperatively with others and be part of a team.
• Curious and positive mindset
• Ability to self-motivate and complete project deliverables without significant oversight.
• Resourceful, proactive, and able to understand and manage complex operational processes.
• Ability to quickly shift gears between various complex project areas and get up to speed quickly on new initiatives.
• Intermediate to advanced experience using Microsoft Word, PowerPoint, and Excel
• Average to above-average experience with manipulating data in Excel.
• Ability to work independently and collaboratively, including establishing and maintaining effective working relationships.
• Strong analytic and problem-solving skills.
• Excellent organization skills, including the ability to manage time, manage multiple tasks, set priorities, and work under time constraints.

Preferred Qualifications :

• Background in health care management, policy, government, Medicare, and/or Medicaid.
• Understanding or experience working with the dual-eligible (medicare and medicaid) population.
• More than 5 years of program, implementation, business planning, or operations experience in a healthcare environment.
• Experience with adapting content and effectively communicating (verbally or in written form) to diverse audiences.
• Familiarity with Tableau, Microsoft Teams, and Smartsheets.

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:

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

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.

Qualifications

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.

Official Title : Administrator IV

Primary Location : United States-Massachusetts-Boston-1 Ashburton Place

Job : Administrative Services

Agency : Exec Office Of Health and Human Services

Schedule : Full-time

Shift : Day

Job Posting : Mar 5, 2024, 9:41:37 AM

Number of Openings : 1

Salary : 75,714.27 - 116,389.58 Yearly

If you have Diversity, Affirmative Action or Equal Employment Opportunity questions or need a Reasonable Accommodation, please contact Diversity Officer / ADA Coordinator : Diane Randolph-Jones / [email protected] - 8577570096

Bargaining Unit : M99-Managers (EXE)

Confidential : No

Potentially Eligible for a Hybrid Work Schedule : Yes

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