Job Description
MassHealth's Integrated Care team reports directly to the Chief of Long-Term Services and Supports and is responsible for MassHealth's integrated care delivery systems: One Care, Program of All-inclusive Care for the Elderly (PACE) Organizations, and Senior Care Options (SCO), including for individuals eligible for Medicare and Medicaid (dual eligibles). The Integrated Care Operations Manager, reporting to the Special Projects and Operations Manager, is responsible for daily operational correspondence and reporting essential for the seamless functioning of the Integrated Care program. This role also supports the operationalization of policy and program initiatives for Integrated Care.
The Integrated Care Operations Manager will assist in creating, manipulating, and disseminating several recurring reports. This position will support the coordination of multiple operational transition projects within Integrated Care and participate in efforts and workgroups impacting One Care, PACE, and SCO. Additionally, the manager will investigate and resolve ongoing member-specific enrollment issues, requiring effective collaboration and communication across multiple MassHealth departments. As needed, they will also support the development of internal process improvements focused on practical, streamlined solutions.
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Duties and Responsibilities (these duties are a general summary and not all inclusive):
Coordinate Integrated Care Internal Operations:
- Coordinate projects across teams and departments, managing planning and implementation efforts.
- Contribute to cross-team projects addressing state and federal requirements, operational changes, and updates to policies or enrollment practices.
- Support Integrated Care Program leads and Contract Managers by facilitating communications and compiling documentation.
- Act as a subject matter expert and liaison for enrollment, eligibility, and managed care operations.
- Document and organize operational policies and standard operating procedures for reference and implementation support.
- Build and maintain collaborative relationships with peers, other MassHealth teams, state agencies, and CMS.
- Lead or participate in special projects to improve operational efficiency and enhance MassHealth member and provider experiences.
- Recommend and implement strategies for operational improvements, escalating issues as necessary within MassHealth and CMS.
- Participate in training to enhance knowledge and skills related to Medicare and Medicaid enrollment policies and regulations.
Resolve Member Eligibility and Enrollment Issues
- Serve as main point of contact for the MassHealth Enrollment Operations and Eligibility teams for member enrollment issues and escalations
- Research and resolve enrollment and eligibility issues,
- Identify solutions, recommend policy/program changes, and oversee implementation of updates.
- Analyze data, applying insights to support policy and procedure changes.
- Prepare and distribute operational reports to internal and external stakeholders per reporting schedules.
- Demonstrate strong problem-solving skills, with a commitment to seeing issues through to resolution.
- Approach problems with a proactive, hands-on attitude, willing to engage deeply in difficult tasks and overcome obstacles.
- Advocate for the best outcomes for members, ensuring their well-being and preferences are at the forefront of the decision-making processes.
Support Integrated Care Partners:
- Become an expert in MassHealth's operational interactions with Integrated Care Plans and work with the Special Projects and Operations Manager to recommend improvements
- Assist the Special Projects and Operations Manager in drafting external training documents and SOPs for Integrated Care Plan partners
- Assist Integrated Care Plan Partners in resolving technical and operational problems. Collaborate with the Contact Management, MMIS, Enrollment Operations and BSS teams to find resolutions.
- Build and maintain productive relationships with Integrated Care Plan Operations and IT contacts.
- Support training and outreach sessions for Integrated Care Plans as required.
- Maintain open communication with internal, external, and interagency stakeholders to promote collaboration and coordination.
- Remain informed about the unique challenges faced by Medicare and Medicaid members and use this knowledge to drive effective solutions and improvements.
- Perform other duties as required.
Required Qualifications:
- At least four years of project management, implementation, business planning, or operations experience preferably in a healthcare environment.
- Experience managing both short- and long-term projects
- Ability to set goals and pursue excellence or improvement.
- Passion for public service.
- Strong analytic and problem-solving skills.
- Ability to Identify problems or opportunities and take proactive action to address them.
- Strong collaborator who works effectively as part of a team.
- Self-motivator who can deliver project outcomes with minimal oversight.
- Resourceful and proactive in managing complex operational processes.
- Adaptable and able to support various project areas and familiarize oneself with new initiatives.
- Experience with adapting content and effectively communicating to diverse audiences.
- Curious and positive mindset, passionate about MassHealth and willing to learn
- Strong technical mindset, is willing to learn how to use new tools and systems
- Intermediate to advanced experience using Microsoft Word, PowerPoint, and Excel.
- Excellent organization skills, including the ability to manage time, manage multiple tasks, set priorities, and work under time constraints
Preferred Qualifications:
- Background in health care management, policy, government, Medicare, and/or Medicaid.
- Understanding or experience working with the dual-eligible (Medicare and Medicaid) population.
- Experience working with managed care organizations
- More than 5 years of program, implementation, business planning, or operations experience in a healthcare environment.
- Experience with MassHealth systems (POSC, MMIS, MA-21, HIX)
- Experience using Microsoft Access
TO APPLY:
Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.
About MassHealth:
The mission of MassHealth is to improve the health outcomes of our diverse members, their families, and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence, and quality of life.
For more information about our agency and programs please visit: www.mass.gov/masshealth
Pre-Offer Process:
A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori
Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines.
Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.
If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form.
For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.
Qualifications
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) four (4) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below.
Substitutions:
I. A certificate in a relevant or related field may be substituted for one (1) year of the required experience.
II. An Associate's degree in a related field may be substituted for one (1) year of the required experience.
III. A Bachelor's degree in a related field may be substituted for two (2) years of the required experience.
IV. A Graduate degree in a related field may be substituted for three (3) years of the required experience.
V. A Doctorate degree in a related field may be substituted for the required experience.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics? Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.