Mass General Brigham Health Plan
Director, Contracting, One Care 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 at Assembly Row.
The Director, Contracting - DSNP is responsible for developing short- and long-term strategies, systems, and processes to manage the daily operation of contracting for the DSNP product with an emphasis in the ancillary and community-based provider space (LTSS, CBO, etc.). This role ensures the existing and future contracted provider network serves the operational and financial requirements and strategic goals of Mass General Brigham Health Plan and its members in the D-SNP (One Care / Senior Care Options) and related government spaces within their respective service areas. This role will successfully develop and execute on department and corporate strategies and initiatives.
Principal Duties and Responsibilities: Direct various operational management aspects of contracting including information gathering, negotiation, implementation, and reporting through the management of staff and positive relations with providers and internal departments. Fully develop the network of providers to support the D-SNP product with an emphasis on building out the ancillary and community-based providers space (LTSS, CBO, etc.). Maintain the contracting calendar for government lines of business, with workflows designed to standardize and optimize leadup to contract renewals. Oversee team in order to renew contracts timely and within target budget. In collaboration with Contract Finance, establish financial reimbursement targets for provider contracts. Assures that all contracts are in compliance with the financial requirements of Mass General Brigham Health Plan and relevant state / federal regulators. Develop financial and operational goals and metrics. Develop auditing modules to ensure that the financial and operational goals and metrics are being achieved. Assure that all contracts are compliant with the operational, quality and legal requirements of Mass General Brigham Health Plan and relevant regulators. Strategically manage in-force contracts assuring provider support, timely reporting, information sharing and contract compliance. Assure modification of contracted provider network as goals of Mass General Brigham Health Plan or membership changes. Serve as key team member in formulating and modifying strategic goals and planning. Develop solutions to complex provider issues related to network management and contracts. Serve as a subject matter expert for D-SNP and associated lines of business including a nuanced understanding of contracting requirements for the ancillary and community-based providers spaces including LTSS, CBO, etc. Understand, develop and implement innovative risk sharing / value-based arrangements, and alternative payment models with emphasis on ancillary and community-based provider spaces. Understand relevant network adequacy requirements, periodically monitor network relative to these requirements and direct contracting strategies to ensure network not only meets standards but is optimized for member experience. Apply in-depth knowledge of organizational and program specific goals to ensure contracting efforts align with underlying strategies. Execute on cross-functional initiatives with enterprise data analytics team to strengthen contracting efforts. Participate in relevant training related to government programs, including but not limited to clinical needs, health plan / community relations, social determinants of health, model of care, long-term support services, etc. Provide cross-functional support to Provider Relations by maintaining an understanding of provider needs within the marketplace. Review and implement changes to contracting operations to assure most efficient and accurate processes and minimize inefficiencies and redundancies. Identify and implement cost control mechanisms within contracts while preserving and/or improving quality of care for members. Direct and lead the implementation of and negotiations for provider contracts through staff or directly with more complex or key providers. Manage the contracting staff to include hiring, work allocation, scheduling, training and professional development, problem resolution, goal development, performance evaluation and related supervisory duties. Work in collaboration with Operations and IT to ensure that all contract processes, policies, and workflows are optimally designed to maximize efficiencies and to reflect industry best practices. 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. Collaborate cross-functionally to support provider operations including with the areas of Provider Relations, Provider Enrollment and Credentialing. 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 hold regular development meetings. Ensure diversity, equity, and inclusion are integrated as a guiding principle. Ensure team is educated on and held accountable to commitments required by federal and state agencies. Hold self and others accountable to meet commitments both internally and externally. Persist in accomplishing objectives to consistently achieve results despite any obstacles or setbacks. 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 (master's degree preferred). 10+ years' managed care experience with ancillary, community-based provider relationships and providers of Long-term Services and Supports (LTSS), including 5+ years management experience. Successful negotiation / leadership experiences. Nuanced understanding of both the Federal (CMS) and State (Massachusetts EOHHS) regulatory environment, including One Care and Senior Care Options programs. Detailed knowledge of contract compliance and issues, and contract processes in a managed care environment. Proven ability to solve problems through effective use of analytical tools, software, and systems. Proven leadership, decision-making and consensus and relationship building skills.
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 Network Management
Job Posting:
Nov 22, 2024
#J-18808-Ljbffr
The Director, Contracting - DSNP is responsible for developing short- and long-term strategies, systems, and processes to manage the daily operation of contracting for the DSNP product with an emphasis in the ancillary and community-based provider space (LTSS, CBO, etc.). This role ensures the existing and future contracted provider network serves the operational and financial requirements and strategic goals of Mass General Brigham Health Plan and its members in the D-SNP (One Care / Senior Care Options) and related government spaces within their respective service areas. This role will successfully develop and execute on department and corporate strategies and initiatives.
Principal Duties and Responsibilities: Direct various operational management aspects of contracting including information gathering, negotiation, implementation, and reporting through the management of staff and positive relations with providers and internal departments. Fully develop the network of providers to support the D-SNP product with an emphasis on building out the ancillary and community-based providers space (LTSS, CBO, etc.). Maintain the contracting calendar for government lines of business, with workflows designed to standardize and optimize leadup to contract renewals. Oversee team in order to renew contracts timely and within target budget. In collaboration with Contract Finance, establish financial reimbursement targets for provider contracts. Assures that all contracts are in compliance with the financial requirements of Mass General Brigham Health Plan and relevant state / federal regulators. Develop financial and operational goals and metrics. Develop auditing modules to ensure that the financial and operational goals and metrics are being achieved. Assure that all contracts are compliant with the operational, quality and legal requirements of Mass General Brigham Health Plan and relevant regulators. Strategically manage in-force contracts assuring provider support, timely reporting, information sharing and contract compliance. Assure modification of contracted provider network as goals of Mass General Brigham Health Plan or membership changes. Serve as key team member in formulating and modifying strategic goals and planning. Develop solutions to complex provider issues related to network management and contracts. Serve as a subject matter expert for D-SNP and associated lines of business including a nuanced understanding of contracting requirements for the ancillary and community-based providers spaces including LTSS, CBO, etc. Understand, develop and implement innovative risk sharing / value-based arrangements, and alternative payment models with emphasis on ancillary and community-based provider spaces. Understand relevant network adequacy requirements, periodically monitor network relative to these requirements and direct contracting strategies to ensure network not only meets standards but is optimized for member experience. Apply in-depth knowledge of organizational and program specific goals to ensure contracting efforts align with underlying strategies. Execute on cross-functional initiatives with enterprise data analytics team to strengthen contracting efforts. Participate in relevant training related to government programs, including but not limited to clinical needs, health plan / community relations, social determinants of health, model of care, long-term support services, etc. Provide cross-functional support to Provider Relations by maintaining an understanding of provider needs within the marketplace. Review and implement changes to contracting operations to assure most efficient and accurate processes and minimize inefficiencies and redundancies. Identify and implement cost control mechanisms within contracts while preserving and/or improving quality of care for members. Direct and lead the implementation of and negotiations for provider contracts through staff or directly with more complex or key providers. Manage the contracting staff to include hiring, work allocation, scheduling, training and professional development, problem resolution, goal development, performance evaluation and related supervisory duties. Work in collaboration with Operations and IT to ensure that all contract processes, policies, and workflows are optimally designed to maximize efficiencies and to reflect industry best practices. 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. Collaborate cross-functionally to support provider operations including with the areas of Provider Relations, Provider Enrollment and Credentialing. 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 hold regular development meetings. Ensure diversity, equity, and inclusion are integrated as a guiding principle. Ensure team is educated on and held accountable to commitments required by federal and state agencies. Hold self and others accountable to meet commitments both internally and externally. Persist in accomplishing objectives to consistently achieve results despite any obstacles or setbacks. 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 (master's degree preferred). 10+ years' managed care experience with ancillary, community-based provider relationships and providers of Long-term Services and Supports (LTSS), including 5+ years management experience. Successful negotiation / leadership experiences. Nuanced understanding of both the Federal (CMS) and State (Massachusetts EOHHS) regulatory environment, including One Care and Senior Care Options programs. Detailed knowledge of contract compliance and issues, and contract processes in a managed care environment. Proven ability to solve problems through effective use of analytical tools, software, and systems. Proven leadership, decision-making and consensus and relationship building skills.
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 Network Management
Job Posting:
Nov 22, 2024
#J-18808-Ljbffr