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, Senior Care Options (SCO), and Program of All-inclusive Care for the Elderly (PACE) Organizations, including for individuals eligible for Medicare and Medicaid (dual eligibles).
The Integrated Care Contract Manager provides direct support to the Deputy Director for Integrated Care Plan and Clinical Management to directly manage day-to-day engagement with, and oversight of, One Care, SCO, and PACE contracts. The Integrated Care Contract Manager also provides indirect and ad hoc support to the One Care Program Manager and the SCO/PACE Program Manager for management of the integrated care plans.
Smart, curious, self-motivated individuals skilled in contract, vendor, and program management, effective communication, collaborating in a team environment, and preferably having prior exposure to state or federal program management, managed care, health care programs or policy, and government are encouraged to apply.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
* Serve as the Key Contact and primary interface for designated integrated care plans. Work closely with staff in MassHealth’s Office of Long-Term Services and Supports (OLTSS) and Office of Behavioral Health, as well as staff in Eligibility, Operations, Finance, Strategy, Payment and Care Delivery Innovation, Legal, Office of Clinical Affairs, Program Integrity/Compliance Office and other MassHealth units to manage contracted entities.
* Develop productive relationships with integrated care plan key contacts and provide technical support and assistance as needed to plans.
* Handle member and other external inquiries and concerns effectively and with compassion.
* Monitor the performance of integrated care plans to ensure compliance with contractual requirements including, but not limited to, all contractual reporting requirements, grievance and appeals processes, and the resolution of individual appeals, complaints, and denied claims.
* Use quality, financial and other performance data to monitor and manage assigned integrated care plans toward improved performance and member outcomes.
* 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.
* Work closely with the OLTSS leadership team and quality staff to oversee quality management and program evaluation for assigned integrated care plans.
* Coordinate the research of answers and issue resolution related to covered benefits, member access to care, and other program related items.
* Review plan marketing material submissions, annual benefits material submissions, audit materials, and other required materials as needed.
* Participate collaboratively in state/federal partnerships, including contract management and program management activities
* Conduct or participate in training and outreach sessions for integrated care 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.
Preferred Qualifications:
* Degree in a related field, especially health or social policy, public administration, public health, law, social work, or management.
* Three to five years of program or contract management experience in a health care environment with emphasis on managed care programming.
* Ability to communicate effectively, both orally and in writing.
* Experience with health care quality improvement processes.
* Ability to work independently and collaboratively, including establishing and maintaining effective working relationships.
* Strong analytic and problem-solving skills.
* Excellent organization skills, including ability to manage time, to manage multiple tasks, to set priorities, and to work under time constraints.
* Experience effectively using project management techniques and tools, such as Microsoft Projects and Microsoft Planner.
* Strong presentation skills.
* Ability to maintain accurate records and experience handling confidential information.
* Ability to interpret policies and procedures in written and verbal responses to requests for information.
* Experience in the healthcare industry, in a managed care environment.
* Experience presenting information in Microsoft Word, PowerPoint, and Excel.
* Knowledge of managed care reimbursement principles, and state and federal Medicare/Medicaid financing rules and regulations.
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:
To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable 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 .
For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #2.
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?
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.
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