The Medicaid ACO Program Operations Manager is a structured, self-driven, collaborative and process-oriented thinker with a strong interest in health plan Medicaid program operations and compliance. He/she is responsible for managing all aspects of BMC HealthNet Plan’s MassHealth accountable care organization (ACO) program operations as well as supporting managed care organization (MCO) program operations as needed. Reporting to the Director of Medicaid Program Operations, the ACO Program Operations Manager oversees health plan MassHealth ACO contractual deliverables and serves as the internal day-to-day subject matter expert with respect to the implementation of the MassHealth ACO contractual program requirements into actionable operations processes that drive the organization’s performance in the market. Externally, the Medicaid ACO Program Operations Manager acts as the key liaison with the MassHealth ACO Program Compliance and Program Operations unit, representing BMCHP values.
KEY FUNCTIONS/RESPONSIBILITIES:
- Provides guidance and leadership across company departments in transforming MassHealth ACO program requirements into actionable, cost-efficient, and compliant business solutions.
- Ensures compliance with MassHealth ACO program requirements and contract deliverables involving significant cross-functional interface, complexity, risk and/or cost.
- Serves as the BMCHP designated key contact/primary liaison with the assigned MassHealth ACO Contract or Account Manager.
- Supports ACO Partners directly and in coordination with ACO Account Managers in connection with MassHealth program communications, including updates, and the completion of ACO program deliverables.
- Leads and coordinates the analysis and implementation of ACO contract amendments, revised and new regulatory requirements, and provides ongoing guidance to affected business areas, while ensuring compliance in a manner that maximizes efficiency.
- Identifies management and systemic solutions to new and changing MassHealth ACO program requirements, internally ensuring clear understanding of the requirements and externally, representing the visions and values of BMCHPtoMassHealth.
- Oversees content accuracy and quality of MassHealth ACO program reports as well as external quality review deliverables as defined in the ACO contract.
- Provides guidance on root cause analysis for complex issues that affect program performance and works collaboratively with other departments to design and implement solutions.
- Participates in projects, committees, and workgroups affecting the MassHealth ACO program, and provides guidance and recommendations that ensure compliance with program requirements.
- Supports BMCHP senior leadership on initiatives and projects related to any aspects or developments related to any Medicaid programs opportunities, innovation, procurements, and re-procurements
- Provides support on MassHealth MCO program deliverables, including contract compliance, operations support, reporting, and communications with the MassHealth MCO Contract or Account Manager as needed.
QUALIFICATIONS:
Education:
- Bachelor’s Degree in such fields as Public Health, Business, Legal Studies, Healthcare, Government Relations, or Social Sciences, or an equivalent combination of education, training and experience is required.
- Master’s Degree in Public Administration, Public Health or Business is desirable.
Experience:
- 7+ years of experience in health care/health insurance, managed care, Medicaid, Medicare or Public Exchange product management, coupled with demonstrated ability to build and lead effective teams and successfully plan, organize and manage projects.
Competencies, Skills, and Attributes:
- Confident taking ownership of workstreams with high-level direction and guidance, and producing proposed plans of action in a self-driven manner.
- Collaborative approach to problem-solving and performance improvement.
- Experience managing implementation or performance improvement projects, including producing workplans and managing to them.
- Knowledgeable and adaptable to program and Health Care Reform developments and changes.
- Strong background in health insurance, Medicaid, Medicare, Affordable Care Act, federal Demonstration programs and managed care.
- Ability to effectively communicate issues, findings, and recommendations both verbally and in writing to all levels of management, external stakeholders, and regulatory agencies.
- Ability to build relationships and alliances and successfully to interact within all levels of the organization and external stakeholders.
- Excellent business writing, proof reading and editing skills.
- Effective analytical, consulting skills and leadership skills.
- Ability to build and lead effective teams.
- Strong focus on service to internal and external customers.
- Ability to prioritize and organize work and to multi-task when required.
- Ability to work independently and collaboratively, manage multiple projects and meet scheduled deadlines.
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Ability to travel to and within Massachusetts.
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required Skills
Required Experience