MassHealth Program Manager

8925 Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Remote; USD 64,000 - 93,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a skilled project or program manager to support MassHealth appeals and claims resolution, and to coordinate regulatory reporting.

This remote role collaborates across departments to ensure timely submission and compliant governance within an integrated health care system. The position requires a Bachelor's degree and 3–5 years of PM experience, with 1–2 years in MassHealth or government programs preferred.

Qualifications

• Bachelor's degree required; experience can be considered in lieu of a degree.
• 3-5 years of project or program management experience.
• 1-2 years experience with Medicaid, MassHealth or government programs preferred.
• 1-2 years experience managing reporting processes and compliance workflows preferred.

Responsibilities

• Coordinate MassHealth operational activities and initiatives, tracking deliverables and timelines.
• Prepare, compile, and submit routine MassHealth regulatory reports and contractual deliverables.
• Receive, track, and distribute MassHealth communications to stakeholders and monitor responses.
• Coordinate governance, committee, and meeting activities and maintain action-item logs.
• Support MassHealth operational processes including updates, tracking, and provider enrollment coordination.

Skills

Project management

Regulatory reporting

Communication

Stakeholder collaboration

Education

Bachelor's Degree

Tools

SharePoint

Excel

PowerPoint

Teams

Job description

Site: Mass General Brigham Health Plan Holding Company, Inc. 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.

Job Summary

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. Responsible for supporting the appeals and claims resolution process, ensuring timely submission and follow-up on appeals. Assists with gathering documentation, tracking case statuses, and coordinating communications between departments to ensure the accurate handling of claims This role supports the day-to-day administration and operations of the MassHealth line of business. Working under the guidance of leadership, this role coordinates regulatory reporting, operational processes, stakeholder communications, and governance activities to support compliance with contractual requirements and organizational objectives. The position maintains documentation, tracks deliverables and action items, facilitates communication among stakeholders, and assists with the execution of MassHealth-related initiatives. The role follows established policies, procedures, and priorities while escalating complex issues and recommendations to leadership.

Essential Functions

• Coordinate assigned MassHealth operational activities and initiatives by maintaining timelines, tracking deliverables, documenting progress, and following up with stakeholders to support the timely completion of work.
• Prepare, compile, and submit routine MassHealth regulatory reports and contractual deliverables, including quarterly, semi-annual, annual, and ad hoc submissions, in accordance with established requirements and timelines.
• Receive, track, and distribute MassHealth communications to appropriate stakeholders; monitor responses and follow-up activities; and elevate issues requiring management review or decision-making.
• Coordinate governance, committee, and meeting activities by scheduling meetings, preparing materials, documenting meeting outcomes, maintaining action-item logs, and supporting follow-up activities.
• Support MassHealth operational processes, including benefit and reimbursement updates, bulletin and transmittal tracking, redetermination activities, member assignment processes, provider enrollment coordination, PIDSL maintenance, practice closure activities, discharge tracking, and related system updates.
• Maintain reporting calendars, submission schedules, templates, process documentation, and departmental records to support compliance with MassHealth contractual requirements.
• Assist internal stakeholders in collecting information, monitoring operational activities and coordinating follow-up actions related to quality, health equity, care management, member experience, provider operations, finance, community partner performance, and MGB ACO initiatives.
• Maintain shared resources, systems access, and departmental tools, including OnBase, POSC, Virtual Gateway, SharePoint, Teams sites, reporting libraries and reference materials.
• Produce routine reports, maintain operational data and documentation, and support leadership in monitoring departmental performance and compliance activities.
• Identify operational issues, process gaps, or delays and communicate findings to leadership for review and guidance.
• Perform other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Education: Bachelor's Degree required; experience can be considered in lieu of a degree.
• Experience: At least 3-5 years of experience in project or program management required.
• Experience: At least 1-2 years of experience with Medicaid, MassHealth or government programs preferred.
• Experience: At least 1-2 years of experience managing reporting processes and compliance workflows preferred.

Knowledge, Skills, and Abilities

• Excellent interpersonal and communication skills, with the ability to engage and collaborate with staff at all levels.
• Excellent project/program management skills, including planning, scheduling, budgeting and risk management, with the ability to effectively coordinate and delegate tasks, manage timelines, and drive results.
• Strong analytical and problem‑solving abilities, with attention to detail and accuracy.
• Effective communication and interpersonal skills, with the ability to manage relationships with diverse stakeholders.
• Proficiency in Microsoft Office Suite (including SharePoint, Excel, PowerPoint and Teams), Copilot and data management software.
• Ability to work collaboratively in a team environment.

Additional Job Details (if applicable)

Working Conditions: This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occasional in-person meetings.

This is a Monday-Friday role with standard business hours (in Eastern time).

Remote Type: Remote Work Location 399 Revolution Drive.

Scheduled Weekly Hours: 40.

Employee Type: Regular Work Shift Day (United States of America).

Pay Range: $63,648.00– $92,570.40/Annual Grade 6.

At 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 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, 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.

Combat disease. Hold a hand.Help people. Impact the world.

Mass General Brigham is a passionate, welcoming community where minds meet caring hearts. Come be a part of the world’s most powerful force in medicine, where every role is important in changing lives. Are you ready? Our history includes New England hospitals founded over 200 years ago, some of the first and most prestigious hospitals in the world. Built on the legacy of two leading academic medical centers, we’re more than a system—we’re leaders in the practice of medicine. Mass General Brigham is committed to serving the community. We are dedicated to enhancing patient care, teaching and research, and taking a leadership role as an integrated health care system. We recognize that increasing value and continuously improving quality are essential to maintaining excellence.