Integrated Care Contract Coordinator

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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, Senior Care Options (SCO), and Program of All-inclusive Care for the Elderly (PACE) Organizations.

The Integrated Care Contract Coordinator provides direct support to the Deputy Director of Plan Administration and Oversight to manage day-to-day engagement with, and oversight of, One Care, SCO, and PACE contracts. The Integrated Care Contract Coordinator also provides indirect and ad hoc support to the One Care Program Manager, the SCO/PACE Program Manager, and the Integrated Care Senior Policy Manager for management of the integrated care plans.

Smart, curious, self-motivated individuals skilled in contract, vendor, and program management, effective communication, collaborating in a team environment, and preferably having prior exposure to state or federal program management, managed care, health care programs, or policy are encouraged to apply.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Serve as the Key Contact and primary interface for designated integrated care plans.

• Work closely with staff in MassHealth's Office of Long Term Services and Supports (OLTSS) as well as staff in Eligibility, Operations, Finance, Strategy, Legal, Office of Clinical Affairs, Program Integrity and other MassHealth units to manage contracted entities.

• Develop productive relationships with integrated care plan key contacts and provide technical support and assistance as needed to integrated care plans.

• Handle member and other external inquiries and concerns effectively and with compassion.

• Monitor the performance of integrated care plans to ensure compliance with contractual requirements including, but not limited to, all contractual reporting requirements, grievance and appeals processes, and the resolution of individual appeals, complaints, and denied claims.

• Use quality, financial, and other performance data to monitor and manage assigned integrated care plans toward improved performance and member outcomes.

• Lead or participate in special projects and work groups to promote operational efficiencies that will lead to better experience for members and providers engaged in integrated care programs.

• Recommend and implement management strategies and escalate issues appropriately within MassHealth and to CMS.

• Coordinate the research of answers and issue resolution related to covered benefits, member access to care, and other program related items.

• Review plan marketing material submissions, annual benefits material submissions, audit materials, and other required materials as needed.

• Participate collaboratively in state/federal partnerships, including contract management and program management activities.

• Conduct or participate in training and outreach sessions for integrated care as needed.

• Maintain open lines of communication with internal, external, and interagency stakeholders to ensure ongoing collaboration, coordination, and input.

• Perform other duties as required.

Preferred Qualifications:

• Program or contract coordination experience in a health care environment with emphasis on managed care programming.
• Ability to communicate effectively.
• Ability to work independently and collaboratively, including establishing and maintaining effective working relationships.
• Strong analytic and problem-solving skills.
• Excellent organization skills, including ability to manage time, to manage multiple tasks, to set priorities, and to work under time constraints.
• Strong presentation skills.
• Ability to maintain accurate records and experience handling confidential information.
• Ability to interpret policies and procedures in written and verbal responses to requests for information.
• Experience in the healthcare industry.
• Experience analyzing information in Microsoft Word, PowerPoint, and Excel.

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.

ADA Reasonable Accommodation: If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests.

For questions, please contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122 and select option #4.

'',''!*!

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, Senior Care Options (SCO), and Program of All-inclusive Care for the Elderly (PACE) Organizations.

The Integrated Care Contract Coordinator provides direct support to the Deputy Director of Plan Administration and Oversight to manage day-to-day engagement with, and oversight of, One Care, SCO, and PACE contracts. The Integrated Care Contract Coordinator also provides indirect and ad hoc support to the One Care Program Manager, the SCO/PACE Program Manager, and the Integrated Care Senior Policy Manager for management of the integrated care plans.

Smart, curious, self-motivated individuals skilled in contract, vendor, and program management, effective communication, collaborating in a team environment, and preferably having prior exposure to state or federal program management, managed care, health care programs, or policy are encouraged to apply.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Serve as the Key Contact and primary interface for designated integrated care plans.

• Work closely with staff in MassHealth's Office of Long Term Services and Supports (OLTSS) as well as staff in Eligibility, Operations, Finance, Strategy, Legal, Office of Clinical Affairs, Program Integrity and other MassHealth units to manage contracted entities.

• Develop productive relationships with integrated care plan key contacts and provide technical support and assistance as needed to integrated care plans.

• Handle member and other external inquiries and concerns effectively and with compassion.

• Monitor the performance of integrated care plans to ensure compliance with contractual requirements including, but not limited to, all contractual reporting requirements, grievance and appeals processes, and the resolution of individual appeals, complaints, and denied claims.

• Use quality, financial, and other performance data to monitor and manage assigned integrated care plans toward improved performance and member outcomes.

• Lead or participate in special projects and work groups to promote operational efficiencies that will lead to better experience for members and providers engaged in integrated care programs.

• Recommend and implement management strategies and escalate issues appropriately within MassHealth and to CMS.

• Coordinate the research of answers and issue resolution related to covered benefits, member access to care, and other program related items.

• Review plan marketing material submissions, annual benefits material submissions, audit materials, and other required materials as needed.

• Participate collaboratively in state/federal partnerships, including contract management and program management activities.

• Conduct or participate in training and outreach sessions for integrated care as needed.

• Maintain open lines of communication with internal, external, and interagency stakeholders to ensure ongoing collaboration, coordination, and input.

• Perform other duties as required.

Preferred Qualifications:

• Program or contract coordination experience in a health care environment with emphasis on managed care programming.
• Ability to communicate effectively.
• Ability to work independently and collaboratively, including establishing and maintaining effective working relationships.
• Strong analytic and problem-solving skills.
• Excellent organization skills, including ability to manage time, to manage multiple tasks, to set priorities, and to work under time constraints.
• Strong presentation skills.
• Ability to maintain accurate records and experience handling confidential information.
• Ability to interpret policies and procedures in written and verbal responses to requests for information.
• Experience in the healthcare industry.
• Experience analyzing information in Microsoft Word, PowerPoint, and Excel.

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.

ADA Reasonable Accommodation: If you require a reasonable accommodation with the application/interview process, please contact us at: EOHHS Candidate ADA Requests.

For questions, please contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122 and select option #4.

'',''!*!

First consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor''s degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*

II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.*

III. A Bachelor''s or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

• Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) 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.

'',''!*!

First consideration will be given to those applicants that apply within the first 14 days.

MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) four years of full-time, or equivalent part-time, professional, administrative or managerial experience in business administration, business management or public administration the major duties of which involved program management, program administration, program coordination, program planning and/or program analysis, and (B) of which at least one year must have been in a supervisory capacity, or (C) any equivalent combination of the required experience and the substitutions below.

Substitutions:

I. A Bachelor''s degree with a major in business administration, business management or public administration may be substituted for a maximum of two years of the required (A) experience.*

II. A Graduate degree with a major in business administration, business management or public administration may be substituted for a maximum of three years of the required (A) experience.*

III. A Bachelor''s or higher degree with a major other than in business administration, business management or public administration may be substituted for a maximum of one year of the required (A) experience.*

• Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed.

NOTE: No substitutions will be permitted for the required (B) 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.

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