Director, Medicaid ACO Strategy

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 MassHealth, 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 MassHealth 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 MassHealth 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 MassHealth 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.

Essential Functions

• Develop strategic plans for the Medicaid business that are in line with Mass General Brigham Health Plan, MGB ACO and MassHealth 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 MassHealth
• 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 make needs known, collaborate on and influence policies, strategies and plans critical for Medicaid business success; significant cross-functional collaboration is required with Clinical, Quality, IT, Compliance and Government/Regulatory Affairs
• Provide insights to the Clinical group about programs and how they meet contractual, financial and market expectations; recommend enhancements and changes as needed to improve performance
• Develop and manage relationships with external business partners/potential partners including MassHealth, Mass General Brigham ACO, key provider partners in the network, trade organizations, etc.
• Hold self and others accountable to meet commitments
• 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

Education: Bachelor's Degree required

Experience: At least 8-10 years of Healthcare Business Development experience required. At least 5-7 years of Medicaid/Medicare or Dual Eligible Program Management experience required. At least 8-10 years of progressive management experience required. Experience in Medicaid regulation, policies, and procedures highly preferred.

Knowledge, Skills, and Abilities

• Proficient knowledge of government program policies (Medicare/Medicaid/Dual Eligible), requirements, regulations, and reimbursement models.
• Demonstrated understanding of value-based care, accountable care organization models, and population health management.
• Proven track record in strategic planning, business development, leadership, and financial management.
• Excellent analytical, negotiation, and problem-solving skills.
• Exceptional communication and relationship-building abilities.
• Ability to collaborate effectively with various stakeholders and lead cross-functional teams.
• High level of strategic focus.

Working Conditions

This is a hybrid role that requires in-person attendance to team meetings at least 1x/month. This is a Monday-Friday role with standard business hours (in Eastern time). Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy.