Site: Mass General Brigham Health Plan Holding Company, Inc.
In collaboration with the Senior Director, Government programs, manage the vendor oversight programs for government payer programs (Medicare Advantage, Part D, Dual Special Needs Programs) and then state insurance programs. Set up the vendor oversight models, intake monitoring performance reports and evaluate compliance and initiate corrective action and/or process improvement activities. Collaborate with the business to set up oversight model that ensures all services delegates are managed in a compliant and timely way.
Essential Functions:
-Managed vendor corrective action plan processes
-Conduct annual compliance risk assessment of vendors and use results to help craft annual monitoring and auditing program
-Perform annual outreach to vendors to validate its adherence to several federal vendor requirements
-Perform monthly checks of vendor information against government exclusion lists to ensure vendors are eligible for government program participation and payment
-Ensure vendors are prepared to participate in external audits with regulatory agencies
QualificationsEducation- Bachelor's Degree Related Field of Study required and Master's Degree Related Field of Study preferred. Experience can be substituted in lieu of a dgree
Licenses and Credentials- Any certification in health care compliance preferred.
Experience- At least 8-10 years of program management experience required
- At least 1-2 years of team leadership experience required
Knowledge, Skills, and Abilities- Strong oral and written communication skills.
- Ability to deliver presentations to a wide variety of audiences.
- Ability to effectively plan and facilitate meetings and workgroups.
- Excellent organizational skills and attention to detail, ability to work independently, manage multiple tasks and projects, meet deadlines, and manage a schedule.
Additional Job Details (if applicable)Working Conditions- This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville, 2- 3x/month
Remote TypeHybrid
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
Pay Range$99,465.60 - $144,643.20/Annual
Grade8
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
