Sr. Director, Market Planning & Execution(Must Live In Massachusetts)

Job Summary:

The Senior Director of Member Retention & MassHealth Contract Administration drives member retention performance and is the responsible regulatorily required SCO & One Care Contract Director back-up with MassHealth in the Massachusetts market. With regards to member retention, this role defines, implements and is accountable for delivering a coordinated, cross-functional plan throughout the organization and with key partners in the community to engage and support members with the requirement of demonstrating success at minimizing avoidable loss of MassHealth eligibility. With regards to MassHealth contract administration, this role actively fulfills a key personnel requirement in the MassHealth contract, engaging daily with internal stakeholders and the MassHealth Contract Management Team to deliver consistently, timely an accurately against standing and ad hoc contractual requirements. Working in close partnership with the SCO & One Care Contract Director, this position ensures timely regulatory responsiveness, clear coordination, and successful delivery of CCA's contractual obligations.

Essential Functions:

• Develop and implement strategies and align operations to minimize avoidable member loss and contribute to the achievement of committed membership goals.
• Develop and oversee member retention strategies and related work plans to achieve health plan retention goals; the retention strategies and related work plans will engage and hold accountable multiple internal functional areas as well as ensure that key provider retention responsibilities are clear, and aligned to the corporate retention goals. Critically, this role will inform and be accountable for delivering on forecasted eligibility loss rates relative to membership projections and annual budgets.
• Monitor retention metrics, analyze trends, and implement a continuous improvement cycle.
• Represent the work and outcomes to leadership and to external stakeholders who are customers of the process; these external stakeholders include, but are not limited to, advocates and regulators.
• Work daily in partnership with the SCO & One Care Contract Director to ensure that all contractual obligations between the plan and MassHealth are being delivered upon timely, consistently and accurately. These responsibilities include contractual follow-through on both standing, regulatory requirements as well as a high volume of weekly ad-hoc issues and requests from the MassHealth Contract Management Team (CMT).
• Interface consistently with functions across the organization to ensure all contractual requirements of the SCO and One Care programs are understood and adhered to. Where there is confusion around specific requirements or need for regulatory clarification, the Sr. Director will triage these items to the Contract Management Team (CMT) for clarification/resolution.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree required
• Master's degree preferred
• Five (5) years of health plan or policy experience required
• Ten (10) years of health plan or policy experience preferred

Competencies, Knowledge and Skills:

• Strategic Thinking: Ability to develop long-term plans that align with organizational goals.
• Operational Excellence: Skilled in optimizing processes and achieving measurable results.
• Relationship Building: Adept at fostering strong internal and external partnerships and leading through influence.
• Member-Centric Approach: Deep commitment to improving the member experience and outcomes.
• Knowledge of Medicare Advantage rules and regulations.
• Knowledge of MassHealth, or other Medicaid program regulations.
• Knowledge of MassHealth contracts, contract interpretation and deep understanding of operationalizing policies and procedures to ensure compliance with contract requirements; and
• General knowledge of disability laws.

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

$135,600.00 - $237,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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