Vice President, Dual Eligible Programs - Mass General Brigham Health Plan at Mass General Brigham Health Plan in Somerville, Massachusetts

Job Description:

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on 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 consciously inclusive environment where diversity is celebrated.


We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.


The Vice President, Dual Eligible Programs is responsible for the strategic leadership, management, development, implementation and oversight of the health plan's anticipated Dual Eligible Special Needs Plans (D-SNPs or Duals), including the Massachusetts One Care and Senior Care Options (SCO) programs. This role ensures the delivery of high-quality, member-centric healthcare services while driving operational excellence and regulatory compliance. The Vice President will collaborate with cross-functional teams to achieve organizational goals, improve health outcomes, and enhance the member experience.


Strategic Leadership:


• Develop and implement the strategic vision for D-SNP programs in alignment with the overall health plan strategy.


• Collaborate with senior leadership on the design of the D-SNP provider network and care model.


• Collaborate with the Vice President, Medicaid to develop growth and transition opportunities through shared programming.


• Identify and analyze trends, opportunities, and challenges in the healthcare landscape to inform strategic decision-making.


• Foster a culture of innovation and continuous improvement to enhance program performance and member satisfaction.


Operational Management:


• Responsible for launching the D-SNP contracts in Massachusetts, which includes initial design, launch and stabilization as well as managing ongoing day-to-day operations to ensure efficient and effective service delivery.


• Monitor and manage program performance metrics, including financial, clinical, and operational indicators.


• Implement best practices and process improvements to optimize program outcomes and operational efficiency.


Regulatory Compliance:


• Ensure compliance with all federal, state, and local regulations governing D-SNP programs.


• Maintain up-to-date knowledge of regulatory requirements and changes, and proactively address compliance issues.


• Coordinate with legal and compliance teams to manage audits, reporting, and regulatory submissions.


• Collaborate with legal, regulatory affairs and compliance, and vendor alliances and partners teams with regard to procurement responses, readiness reviews, contract implementation and ongoing regulatory oversight.


Member Experience:


• Champion a member-centric approach to care, ensuring that programs meet the needs and preferences of the populations served.


• Develop and implement initiatives to improve member engagement, satisfaction, and health outcomes.


• Design and implement processes to intake and address member concerns and feedback, fostering a culture of responsiveness and continuous improvement.


Collaboration and Stakeholder Engagement:


• Build and maintain strong relationships with internal and external stakeholders, including providers, community organizations, government agencies, consumer advocates and regulators.


• Collaborate with other departments, such as clinical, finance, marketing, and IT, to support program goals and initiatives.


• Represent the organization in industry forums, conferences, and meetings related to D-SNP programs.


Team Leadership and Development:


• Lead, mentor, and develop a high-performing team, fostering a collaborative and supportive work environment.


• Set clear performance expectations, provide regular feedback, and conduct performance evaluations.


• Promote professional development and growth opportunities for team members.


Other:


• Hold self and others accountable to meet commitments.


• Ensure diversity, equity, and inclusion are integrated as a guiding principle.


• 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

• Bachelor's degree in healthcare administration, business administration, public health or related field required or the equivalent combination of training and experience, plus 10+ years of related experience.


• Master's degree preferred.


• Minimum of 10 years of experience in healthcare management, with a focus on managed care, Medicare, and/or Medicaid programs.


• Proven track record of strategic leadership and operational management in a complex healthcare environment.


• In-depth knowledge of regulatory requirements and compliance standards for the Massachusetts Duals programs, One Care and SCO.


• Strong analytical, problem-solving, and decision-making skills.


• Excellent communication, interpersonal, and relationship-building abilities.


• Demonstrated ability to lead and motivate teams, manage change, and drive organizational success.



EEO Statement

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.