Director, Medicaid ACO Strategy

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at 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 welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Reporting to the Vice President, Medicaid, the Director, Medicaid Strategy will be responsible for development and successful execution of ACO strategies to improve member outcomes and drive financial performance. To ensure the optimal performance on the ACO line of business, the ideal candidate must have strong and proven leadership skills, exceptional analytic thinking, experience with Mass Health, understanding of value-based care and current Medicaid policy.

This role leads change efforts by working across the organization at all levels, from direct reports to matrixed and cross-functional resources. This role will interface with Mass Health as well as provider partners to optimize MGB ACO performance in the Medicaid contract. The Director, Medicaid Strategy must be an innovative and collaborative leader with a high level of strategic focus.

This position requires in-depth understanding of current Mass Health contractual requirements such as the primary care sub-capitation program, network requirements, care management and flexible services programs. Additionally, the candidate must possess a strong understanding of Mass Health financing structure and levers to drive performance. This position requires an understanding of current Medicaid policy and how these policies are evolving to anticipate impacts to Mass General Brigham Health Plan’s Medicaid business.

This role collaborates with internal departments including Network Management, Medical Economics, Actuarial, Finance, Data Analytics, Risk Adjustment, Population Health, Enterprise Project Management, Utilization Management, Quality and Customer Service.

• Develop strategic plans for the Medicaid business that are in line with Mass General Brigham Health Plan, MGB ACO and Mass Health priorities to position the ACO for success
• Demonstrate an articulate, comprehensive vision and an understanding of the challenges and opportunities facing the ACO
• Ensure that the overall strategy is clear, consistently evaluated and updated regularly
• Analyze the external market environment and adapt strategies as appropriate
• Partner with medical economics, clinical teams and MGB Population Health to develop strategies to manage medical trend
• Drive and influence Quality and Health Equity Performance to maximize member health outcomes and incentive payments from Mass Health
• Oversee Medicaid product development to ensure a strategy and development plan; champion this development and coordinate the efforts of other senior executives where initiatives align
• Monitor and evaluate financial performance metrics, including medical cost trends, risk adjustment and quality/health equity incentives
• Prepare and present reports to leadership highlighting performance trends including areas of opportunity and risk
• Work across organization lines to…