Senior Manager, Managed Care Initiatives

Job Title

Senior Manager, Managed Care Initiatives (2600043N)

Mass Health is Massachusetts’ Medicaid and CHIP plan, serving approximately 2 million low‑income and disabled residents. A $22 billion annual budget supports insurance premiums, healthcare services, pharmaceuticals, and administrative costs. The Program Integrity Unit, a highly strategic function, leads efforts to identify, prevent, and mitigate fraud, waste, and abuse (FWA) across Mass Health. The Senior Manager reports to the Director of Managed Care Integrity and leads high‑priority projects focused on provider and member fraud prevention in managed care.

• Manage cross‑functional teams and projects across program teams, policy, strategy, analytics, legal, and Program Integrity vendors to develop, refine, and implement managed care program integrity initiatives.
• Engage analytic resources to develop reports that identify aberrant provider billing patterns and over payments within prioritized provider program areas.
• Collaborate across Mass Health teams to develop external‑facing materials that communicate program integrity priorities and processes.
• Assist in operational contract management of multiple Program Integrity vendors, tracking and managing timelines for vendor work streams and deliverables.
• Assist with cross‑functional efforts identified by Program, Finance, and Strategy teams to implement policy and regulatory changes.
• Respond to urgent agency, legislative, or regulatory priorities as identified.

• Excellent analytical and problem‑solving skills.
• Proficiency in MS Excel and PowerPoint.
• Experience analyzing large data sets and providing business requirements to analytics teams.
• Ability to work effectively under high pressure and tight deadlines.
• Strong structure and process management skills for projects.
• Strong interpersonal skills.
• Experience in health policy strongly preferred.
• Knowledge of CMS, Mass Health, managed care, and 1115 waiver policy and regulations preferred.
• Experience with claims data or related analytical experience preferred.
• Demonstrated performance in strategic planning and analysis.

• At least five (5) years of full‑time or equivalent part‑time professional experience in business administration, public administration, clinical administration, or related fields.
• Substitutions: a relevant certificate may replace one (1) year of experience; a bachelor’s degree may replace two (2) years; a graduate degree may replace three (3) years; a doctorate may replace four (4) years.

The mission of Mass Health is to improve the health outcomes of diverse members and families by providing access to integrated health care services that promote sustainable and equitable health, well‑being, independence, and quality of life.

An Equal Opportunity / Affidavit er Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth 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 law.