Director, Medicaid ACO Strategy

Mass General Brigham Health Plan; Somerville (MA); Hybrid; USD 124,000 - 181,000; Full time

Job summary

Mass General Brigham Health Plan seeks a Director, Medicaid Strategy to drive ACO strategies and optimize Medicaid performance in collaboration with MassHealth and provider partners.

The role leads cross-functional teams, informs policy and program development, and focuses on improving member outcomes and financial performance.

Qualifications

• Bachelor's Degree required.
• 8–10 years of Healthcare Business Development experience.
• 5–7 years of Medicaid/Medicare or Dual Eligible Program Management experience.
• 8–10 years of progressive management experience.
• Experience in Medicaid regulation, policies, and procedures highly preferred.

Responsibilities

• Develop strategic plans for the Medicaid business aligned with priorities to position the ACO for success.
• Oversee Medicaid product development and coordinate cross-functional initiatives.
• Monitor financial performance metrics including medical cost trends and risk adjustment.
• Collaborate across Clinical, Quality, IT, Compliance and Government/Regulatory Affairs.
• Provide insights to Clinical on programs meeting contractual, financial and market expectations.

Skills

Medicaid policy

Value-based care

Strategic planning

Financial management

Leadership

Collaboration

Education

Bachelor's Degree

Job description

Site

Mass General Brigham Health Plan Holding Company, Inc.

Job Summary

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at 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 welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. Reporting to the Vice President, Medicaid, the Director, Medicaid Strategy will be responsible for development and successful execution of ACO strategies to improve member outcomes and drive financial performance. To ensure the optimal performance on the ACO line of business, the ideal candidate must have strong and proven leadership skills, exceptional analytic thinking, experience with MassHealth, understanding of value-based care and current Medicaid policy. This role leads change efforts by working across the organization at all levels, from direct reports to matrixed and cross-functional resources. This role will interface with MassHealth as well as provider partners to optimize MGB ACO performance in the Medicaid contract. The Director, Medicaid Strategy must be an innovative and collaborative leader with a high level of strategic focus. This position requires in-depth understanding of current MassHealth contractual requirements such as the primary care sub-capitation program, network requirements, care management and flexible services programs. Additionally, the candidate must possess a strong understanding of MassHealth financing structure and levers to drive performance. This position requires an understanding of current Medicaid policy and how these policies are evolving to anticipate impacts to Mass General Brigham Health Plan's Medicaid business. This role collaborates with internal departments including Network Management, Medical Economics, Actuarial, Finance, Data Analytics, Risk Adjustment, Population Health, Enterprise Project Management, Utilization Management, Quality and Customer Service.

Essential Functions

• *Develop strategic plans for the Medicaid business that are in line with Mass General Brigham Health Plan, MGB ACO and MassHealth priorities to position the ACO for success
• oDemonstrate an articulate, comprehensive vision and an understanding of the challenges and opportunities facing the ACO
• oEnsure that the overall strategy is clear, consistently evaluated and updated regularly
• oAnalyze the external market environment and adapt strategies as appropriate
• oPartner with medical economics, clinical teams and MGB Population Health to develop strategies to manage medical trend
• oDrive and influence Quality and Health Equity Performance to maximize member health outcomes and incentive payments from MassHealth
• *Oversee Medicaid product development to ensure a strategy and development plan; champion this development and coordinate the efforts of other senior executives where initiatives align
• *Monitor and evaluate financial performance metrics, including medical cost trends, risk adjustment and quality/health equity incentives
• oPrepare and present reports to leadership highlighting performance trends including areas of opportunity and risk
• *Work across organization lines to make needs known, collaborate on and influence policies, strategies and plans critical for Medicaid business success; significant cross-functional collaboration is required with Clinical, Quality, IT, Compliance and Government/Regulatory Affairs
• *Provide insights to the Clinical group about programs and how they meet contractual, financial and market expectations; recommend enhancements and changes as needed to improve performance
• *Develop and manage relationships with external business partners/potential partners including MassHealth, Mass General Brigham ACO, key provider partners in the network, trade organizations, etc.
• *Hold self and others accountable to meet commitments
• *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

Education

• Bachelor's Degree required

Experience

• At least 8-10 years of Healthcare Business Development experience required
• At least 5-7 years of Medicaid/Medicare or Dual Eligible Program Management experience required
• At least 8-10 years of progressive management experience required
• Experience in Medicaid regulation, policies, and procedures highly preferred

Knowledge, Skills, and Abilities

• Proficient knowledge of government program policies (Medicare/Medicaid/Dual Eligible), requirements, regulations, and reimbursement models.
• Demonstrated understanding of value-based care, accountable care organization models, and population health management.
• Proven track record in strategic planning, business development, leadership, and financial management.
• Excellent analytical, negotiation, and problem-solving skills.
• Exceptional communication and relationship-building abilities.
• Ability to collaborate effectively with various stakeholders and lead cross-functional teams.
• High level of strategic focus.

Additional Job Details (if applicable)

Working Conditions

• This is a hybrd role that requires in-person attendance to team meetings at least 1x/month
• This is a Monday-Friday role with standard business hours (in Eastern time)
• Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy

Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$124,342.40 - $180,897.60/Annual

Grade

9At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth.

EEO Statement

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.