Senior Director, Medicaid Relationship Management
Company: Fallon Community Health Plan
Location: Worcester
Posted on: May 14, 2022
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Job Description:
Senior Director, Medicaid Relationship
ManagementUS-MA-WorcesterJob ID: 6610Type: Full Time# of Openings:
1Category: Medicare Medicaid ProgramsFallon Health - Corp
HQOverviewFallon Health Vaccination Requirements:To protect the
health and safety of our workforce, members and communities we
serve, Fallon Health now requires all employees to disclose
COVID-19 vaccination status. As of 2/1/2022 all roles not
designated as "Remote" require full COVID-19 vaccination and Fallon
Health will obtain the necessary information from candidates prior
to employment to ensure compliance. Failure to meet the vaccination
requirement may result in rescission of an employment offer or
termination of employment. About Fallon HealthFounded in 1977,
Fallon Health is a leading health care services organization that
supports the diverse and changing needs of those we serve. In
addition to offering innovative health insurance solutions and a
variety of Medicaid and Medicare products, we excel in creating
unique health care programs and services that provide coordinated,
integrated care for seniors and individuals with complex health
needs. Fallon has consistently ranked among the nation's top health
plans, and is accredited by the National Committee for Quality
Assurance for its HMO, Medicare Advantage and Medicaid products.
For more information, visit fallonhealth.org. The Senior Director
is the lead executive responsible for managing Fallon Health's
relationships with multiple current ACO provider partners and
developing new provider partnerships. The Senior Director must have
a demonstrated ability to build and maintain positive relationships
with business partners. The candidate needs to be comfortable
interacting with executive leadership of external entities and
continually gauging satisfaction with Fallon Health. S/he must
effectively position Fallon Health to maintain partnerships with
new ACOs and attract new provider partners. S/he must prioritize
and effectively advocate for the needs of current and prospective
provider partners within Fallon Health. This role will represent
Fallon Health in reprocurement discussions with current and
prospective provider partners and in the ACO Joint Governance
Committee structure with each contracted provider partner. The
Senior Director is responsible for working with each assigned ACO
partner to develop financial and performance targets; develop and
implement performance improvement initiatives; continually monitor
performance; and regularly report results to partners and Fallon
Health executive leadership. The Senior Director will partner
closely with the Senior Director of ACO Product Management, the ACO
Medical Director, the appropriate Provider Contracting managers,
and internal Fallon Health departments to resolve operational or
clinical issues from the provider partners. ResponsibilitiesACO
GrowthLead efforts to successfully contract with selected existing
and/or prospective ACO provider partners.With provider partners,
lead efforts to successfully respond to MassHealth reprocurement
RFP.In partnership with the Senior Director of ACO Product
Management, ensure the successful and timely implementation of ACO
partnerships. Participate in strategy development and ongoing
planning and analysis, including prioritization of target partners
for growth. ACO GovernanceCo-lead ACO Governance with executive
leadership of selected provider partners.Maintain ongoing
communication with provider executive leadership, identifying
issues that require executive attention and framing decision points
for the Governance committee.With the support of ACO Product
Management staff, ensure that all ACO governance decisions are
appropriately documented and that all regulatory and contractual
requirements are satisfied. AdditionalBuilding long-lasting,
mutually beneficial relationships with executive leadership and key
contacts at ACO provider partners.Build strong relationships with
key MassHealth leadership and staff.Develop expertise in MassHealth
contractual requirements and financial models and serve as a
resource for provider partners. Educate and inform clients about
new state regulations and requirements. Intervene as necessary to
ensure compliance. Act as liaison between Fallon and ACO Partners
on day to day issues surrounding the ACO. Remain in frequent
contact with the providers to understand their needs.Build strong
relationships with internal departments to create a better customer
experience. Support and solve problems for clients by understanding
and exceeding their expectations.Partner closely with the Senior
Director of ACO Product Management to resolve any operational
issues raised by the ACO Partners.Partner closely with the Medical
Director to resolve any issues related to the model of care. Work
closely with the Medical Director and provider partner to identify
opportunities for improved performance in utilization, quality and
health equity.Partner closely with the Actuarial department to
understand ACO financial performance and effectively communicate
results to partners and to senior leadership at Fallon
Health.Partner closely with Network Development and Management to
understand the contractual terms with each provider partner.Partner
with Medical Economics to deliver timely, insightful and actionable
information to ACO provider partners. Develop expertise in
understanding of data and reports and effectively explain their
content to partners as needed.Partner with Risk Adjustment to
deliver timely, insightful and actionable information to ACO
provider partners. Develop expertise in understanding MassHealth
risk adjustment methodology and work with Risk Adjustment to ensure
that partners have the information and support they need to
accurately capture risk scores for members.Qualifications10-15
years' progressive leadership experience in managed care required.
Preferred experience includes extensive experience building
positive relationships with senior executives externally and
internally.Ideal would be knowledge of plan operations, finance,
medical economics, product implementation, marketing and product
management.Looking for an individual committed to health equity and
improving health outcomes and experience for the Medicaid
population.This role will leverage excellent presentation and
interpersonal skills Bachelors' degree required, master's degree in
management or related field strongly preferred. JT18 Fallon Health
provides equal employment opportunities to all employees and
applicants for employment and prohibits discrimination and
harassment of any type without regard to race, color, religion,
age, sex, national origin, disability status, genetics, protected
veteran status, sexual orientation, gender identity or expression,
or any other characteristic protected by federal, state or local
laws.PI175575131
Keywords: Fallon Community Health Plan, Worcester , Senior Director, Medicaid Relationship Management, Accounting, Auditing , Worcester, Massachusetts
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