Job Description
The MassHealth Office of Long Term Services and Supports (OLTSS) is responsible for managing a comprehensive system of care for elders and persons with disabilities. OLTSS manages a range of thirteen (13) Fee-For-Service (FFS) programs that includes include Hospice, Home Health Agency (HHA), Independent Nursing (IN), Therapies, DMEPOS programs (Durable Medical Equipment, Oxygen and Respiratory Therapy Equipment, Prosthetics and Orthotics), Personal Care Attendant (PCA), Early Intervention, Adult Foster Care (AFC), Group Adult Foster Care (GAFC), Adult Day Health (ADH), Day Habilitation, Nursing Facilities, Chronic-Disease Rehabilitation Hospitals as well as two coordinated care programs, Senior Care Options (SCO) and the Program of All Inclusive Care for the Elderly (PACE).
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The Program Manager, Adult Foster Care and Group Adult Foster Care Programs manages a network of approximately 275 providers. This work includes Compliance Management, Contract Management, and functioning as Team Lead for the OLTSS AFC/GAFC Team.
The AFC Program served approximately 13,500 members in State Fiscal Year 2024. The GAFC Program served approximately 4000 members in State Fiscal Year 2024.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
- Collaborate with the Strategic Initiatives team, the Senior Manager and the Program Integrity team in managing day-to-day interaction with the OLTSS Third Party Administrator (TPA) related to the execution of their functions relating to AFC and GAFC provider enrollment and credentialing, claims operations, prior authorization, appeals, program integrity and reporting related to the AFC and GAFC programs, and appropriately escalating issues to the Director of Community Based Programs.
- Work with constituent services and the OLTSS External Affairs team to resolve program policy and service delivery issues and to respond to legislative and constituent requests. Collaborate with the OLTSS External Affairs team on drafting talking points, policies, and meeting materials.
- Coordinate with budget, legal, providers, other state agencies and advocacy groups to appropriately implement program and ensure access and quality of care. Draft materials for members, providers, oversee coordination with OLTSS leadership, MassHealth administration, budget, finance, legal, Claims Operations, Board of Hearings, MassHealth Publications, Stakeholders and other state agencies in the development and dissemination of those materials. Lead in the development and implementation of provider training.
- Update existing program regulations and sub-regulatory guidance (bulletins and other communication) and billing instructions as needed.
- Assist other units within the OLTSS, the Executive Office of Elder Affairs, and sister agencies in the state government with information and coordination pertaining to the AFC and GAFC programs.
- Co-lead all stakeholder engagement related to the AFC and GAFC program and develop and maintain effective working relationships with a range of internal and external stakeholders and provide timely communication.
- Oversee provider compliance with all applicable program rules, regulations and sub-regulatory guidance including provider education, engagement and escalation including referral for audit and implementation and management of corrective action plans. Including overseeing onsite visits with providers including but not limited to program audits, site reviews and provider education visits (limited travel required). Oversee GAFC provider compliance with EVV related matters.
- Effectively communicate priority project statuses, risks and outstanding decisions to OLTSS and MassHealth leadership both verbally and in written form under quick timelines including the active and ongoing use of OLTSS project management and tracking tools.
Required Qualifications:
- Ability to set goals and strive for excellence or improvement.
- Ability to identify a problem or opportunity and take action to address current or future problems and opportunities.
- Ability to think through problems, organize information, and identify key factors and underlying causes to generate solutions.
- Ability to work cooperatively with others and be part of a team.
Preferred Qualifications:
- Knowledge of strategic and operational planning processes related to clinical and business operations.
- Experience leading a team of professionals.
- Knowledge and experience in LTSS program policy development, analysis and evaluation.
- Possess strong programmatic knowledge of the AFC and GAFC programs.
- Possess an understanding of the role of data and analysis in driving system change.
- Knowledge of the Massachusetts health care industry and market dynamics related to LTSS.
- Proficiency in Microsoft Excel, Word, and PowerPoint; knowledge of Microsoft Project and Visio is a plus.
- Knowledge of payment reform and care delivery reform strategies, including an understanding of the relationship between payment reforms, delivery system change, quality improvement and customer satisfaction in LTSS.
- Ability to understand, apply and explain pertinent laws, rules, regulations, policies and procedures.
- Knowledge of the methods used in the preparation of charts, graphs and tables, and of the methods of general report writing.
- Ability to analyze and determine the applicability of data, to draw conclusions and to make appropriate recommendations.
- Skilled in problem solving, consensus building, conflict resolution and team building.
- Ability to interpret policies and procedures and provide accurate and timely responses.
- Ability to work independently and collaboratively.
- Ability to manage time and set priorities and reach decisions under pressure.
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.
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.
Salary placement is determined by a combination of factors, including the candidate's years of directly related experience and education, and alignment with our internal compensation structure as set forth by the Human Resources Division's Hiring Guidelines. For all bargaining unit positions (non-management), compensation is subject to the salary provisions outlined in the applicable collective bargaining agreement and will apply to placement within the appropriate salary range .
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.