Mass General Brigham Health Plan
Senior Ancillary Contract Manager, OneCare and Senior Care Options
Mass General Brigham Health Plan, Somerville, Massachusetts, us, 02145
This is a hybrid role that requires regular travel to provider sites and occasional onsite team meetings.
The Senior Ancillary Contract Manager - OneCare & Senior Care Options (SCO) is responsible for the successful evaluation, negotiation, execution, implementation, and ongoing management of contracts with ancillary providers, including Community Based Organizations (CBOs), within the One Care & SCO service area. CBOs, and other ancillary providers, deliver long-term services and supports to enable members of Mass General Brigham Health Plan's Dual Eligible Special Needs Plan to live independently and safely in their preferred community setting. This role will successfully execute on department and corporate strategies and initiatives.
Principal Duties and Responsibilities:
With appropriate support, serves as the lead negotiator for CBOs and other ancillary providers within the One Care & SCO service area including fee-for-service and value-based agreements. Obtains necessary market and analytical information to determine effective contract negotiation strategy and approach. Evaluates, negotiates, and recommends approaches and develops comprehensive proposals to ensure that newly negotiated and existing provider contracts meet financial requirements and achieve corporate initiatives, strategies, and objectives. Ensures contract language and terms are consistent with the organization's desired outcomes. Works independently and diligently throughout the contracting process and in the development and maintenance of relationships with CBOs to ensure appropriate contract performance. Operates as a subject matter expert for long-term support services covered under the Dual Eligible Special Needs Plan and ensures contract strategies align with regulatory requirements and organizational objectives. Understands relevant network adequacy requirements, periodically monitors network relative to these requirements, and executes contracting strategies to ensure network not only meets standards related to long-term services and supports but is optimized for member experience. Serves as a subject matter expert on the structure, needs, and operations of CBOs enabling the development of effective partnerships and fostering meaningful collaboration. Applies in-depth knowledge to align Mass General Brigham Health Plan's organizational goals with the needs of CBOs and other ancillary providers, ensuring mutual success through clear communication, tailored solutions, and strategic support in contracting. Maintains working knowledge of the Model of Care for the Dual Eligible Special Needs plan to ensure contracts align with organizational strategies. Maintains an understanding of enterprise data analytic resources to support cross-functional collaboration with data teams. Supports compliance activities related to network management and government agencies. Represents Provider Contracting as necessary on projects, committees, etc. Participates in relevant training related to both clinical and long-term support services (social determinants of health, clinical needs, health plan/community relations, etc.). Supports internal Provider Relations team in coordinating community outreach, education, and promotional events which engage ancillary providers and leaders in the advancement of long-term services and support resources for health plan members. Maintains and shares knowledge of regulatory, business, and political environments that can and will impact contract discussions. Holds self and others accountable to meet commitments. Ensures diversity, equity, and inclusion are integrated as a guiding principle. Persists in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. Builds strong relationships and infrastructure 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 equivalent combination of training and experience (master's degree preferred). At least 5-7 years managed care experience, including successful negotiation experiences. Experience with CBOs and/or providers of long-term support services preferred. Nuanced understanding of the Massachusetts CBO landscape preferred. Superior financial, analytical, and verbal and written communication skills. Proven ability to work efficiently and effectively with analytical tools, software, and systems. Proven leadership, decision-making, and consensus and relationship-building skills. Strong negotiation skills and experience. Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint. About Us: 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. EEO Statement: 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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment. Primary Location:
MA-Somerville-MGB Health Plan at Assembly Row Work Locations:
MGB Health Plan at Assembly Row, 399 Revolution Drive, Somerville 02145 Job:
Professional/Managerial Organization:
Mass General Brigham Health Plan Schedule:
Full-time Standard Hours:
40 Shift:
Day Job Employee Status:
Regular Recruiting Department:
MGB Health Plan Provider Relations Job Posting:
Nov 25, 2024
#J-18808-Ljbffr
With appropriate support, serves as the lead negotiator for CBOs and other ancillary providers within the One Care & SCO service area including fee-for-service and value-based agreements. Obtains necessary market and analytical information to determine effective contract negotiation strategy and approach. Evaluates, negotiates, and recommends approaches and develops comprehensive proposals to ensure that newly negotiated and existing provider contracts meet financial requirements and achieve corporate initiatives, strategies, and objectives. Ensures contract language and terms are consistent with the organization's desired outcomes. Works independently and diligently throughout the contracting process and in the development and maintenance of relationships with CBOs to ensure appropriate contract performance. Operates as a subject matter expert for long-term support services covered under the Dual Eligible Special Needs Plan and ensures contract strategies align with regulatory requirements and organizational objectives. Understands relevant network adequacy requirements, periodically monitors network relative to these requirements, and executes contracting strategies to ensure network not only meets standards related to long-term services and supports but is optimized for member experience. Serves as a subject matter expert on the structure, needs, and operations of CBOs enabling the development of effective partnerships and fostering meaningful collaboration. Applies in-depth knowledge to align Mass General Brigham Health Plan's organizational goals with the needs of CBOs and other ancillary providers, ensuring mutual success through clear communication, tailored solutions, and strategic support in contracting. Maintains working knowledge of the Model of Care for the Dual Eligible Special Needs plan to ensure contracts align with organizational strategies. Maintains an understanding of enterprise data analytic resources to support cross-functional collaboration with data teams. Supports compliance activities related to network management and government agencies. Represents Provider Contracting as necessary on projects, committees, etc. Participates in relevant training related to both clinical and long-term support services (social determinants of health, clinical needs, health plan/community relations, etc.). Supports internal Provider Relations team in coordinating community outreach, education, and promotional events which engage ancillary providers and leaders in the advancement of long-term services and support resources for health plan members. Maintains and shares knowledge of regulatory, business, and political environments that can and will impact contract discussions. Holds self and others accountable to meet commitments. Ensures diversity, equity, and inclusion are integrated as a guiding principle. Persists in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise. Builds strong relationships and infrastructure 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 equivalent combination of training and experience (master's degree preferred). At least 5-7 years managed care experience, including successful negotiation experiences. Experience with CBOs and/or providers of long-term support services preferred. Nuanced understanding of the Massachusetts CBO landscape preferred. Superior financial, analytical, and verbal and written communication skills. Proven ability to work efficiently and effectively with analytical tools, software, and systems. Proven leadership, decision-making, and consensus and relationship-building skills. Strong negotiation skills and experience. Proficiency in Microsoft Office, including Outlook, Word, Excel, and PowerPoint. About Us: 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. EEO Statement: 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 the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment. Primary Location:
MA-Somerville-MGB Health Plan at Assembly Row Work Locations:
MGB Health Plan at Assembly Row, 399 Revolution Drive, Somerville 02145 Job:
Professional/Managerial Organization:
Mass General Brigham Health Plan Schedule:
Full-time Standard Hours:
40 Shift:
Day Job Employee Status:
Regular Recruiting Department:
MGB Health Plan Provider Relations Job Posting:
Nov 25, 2024
#J-18808-Ljbffr