Medicare Program Manager

Medicare Program Manager-(3295747)

Description

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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 consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Medicare Program Manager will support the Mass General Brigham cross functional teams to meet the Centers for Medicare and Medicaid Services (CMS) contractual and regulatory requirements, improve efficiency and support the advancement of the organization.

The Medicare Program Manager is responsible for managing activities related to annual and ad hoc regulatory requirements, process improvement initiatives, ad hoc projects and strategic business initiatives, and day to day operational oversight.

This role will work cross-functionally with many areas of the company including Product, Pharmacy, Network / Provider Management, Sales, Enrollment, Customer Service, Reimbursement Strategy, Benefits Administration, IT, Claims, Appeals and Grievances, Utilization Management, Quality, Finance and Compliance.

The position is responsible for executing plans that align organizational objectives and targets. This includes developing and meeting project objectives within established timelines and managing associated risks.

The Medicare Program Manager works with consultants, vendors, internal & external customers, subject matter experts, and cross functional teams.

Responsibilities include developing reporting frameworks and providing content for periodic updates and reports to leadership.

This position will work with sponsors and key stakeholders to mobilize and motivate teams. This position is responsible for supporting the direction and approach for the team, resolving conflict, and executing plans with limited information and ambiguity.

The Medicare Program Manager is a collaborative problem solver and must be comfortable within in a self-directed manner.They possess strong improvement, communication and documentation skills.

Responsibilities :

• Develop, maintain and execute detailed project plans for the Medicare program annual implementation efforts and the implementation of new regulatory requirements across multiple functional areas.
• Identify involved functional areas and work collaboratively to ensure each has a comprehensive understanding of the project;

conduct gap analyses and escalate scope / schedule / resource risks and issues.

• Provide frequent updates to Medicare governance structures related to program status, performance and escalations.
• Conduct project planning, issue tracking / resolution, and overall management of a project teams.
• Work with internal & external customers to understand issues and recommend and vet solutions, resolve conflict, and manage the project objectives & target dates.
• Initiate and facilitate planning meetings and workgroups within and across functional areas / teams.
• Collaborate with stakeholders to define solutions, scope, requirements, business processes, delivery approach and implementation plan parameters.
• Effectively use tools to increase effective brainstorming & decision making amongst project teams.
• Develop workflow & process flow diagrams to help identify improvement opportunities and collaborate with IT for implementing automated solutions.
• Aid in the development and maintenance of policies and procedures that meet operational needs and compliance requirements.
• Collaboratively manage and maintain the dedicated internal resource repositories in SharePoint.
• Provide project support required for successful & timely project execution.
• Identify, initiate, and conclude process improvement opportunities.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications

Qualifications :

• Bachelor’s degree required or the equivalent combination of training and experience, plus 7+ years of related experience.
• Prior experience working cross-functionally in government programs, experience in Medicare Advantage preferred.
• Strong project management skills.
• Exceptional communication skills.
• Ability to understand ambiguous problems, help frame issues to cross-functional stakeholders and facilitate discussions to drive to solutions.
• Strong ability to influence without formal authority

Skills / Abilities / Competencies :

• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where it’s needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see what is and envision what could be.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Strong verbal, active listening, and written communication skills required.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

Supervisory Responsibilities :

This role does not have direct supervision of FTEs; however, demonstrating leadership in the following areas is required :

oMotivates and encourages staff; leads through change and adversity.

oCommunicates and cascades information to employees in a timely manner and actively participates in the success of cross-organizational programs and initiatives.

oSets clear goals and objectives and uses metrics to measure performance and hold staff accountable. Recognizes staff for their contributions.

oInform, engage, inspire, motivate, and actively listen to employees.

oIdentify / create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.

oEnsure diversity, equity, and inclusion are integrated as a guiding principle.

Primary Location

MA-Somerville-MGB Assembly Row

Work Locations

MGB Assembly Row399 Revolution Drive Somerville02145

Professional / Managerial

Organization

Mass General Brigham Health Plan

Schedule

Full-timeStandard Hours : 40

Shift

Day Job

Employee Status

RegularRecruiting Department : MGB Health Plan Sales

Job Posting

Jul 9, 2024