Director, Public Partnerships

WellSense Health Plan•Remote,

1d•$120,500 - $175,000•Remote

About The Position

The Director, Public Partnerships represents the mission, vision and values of BMCHP/Well Sense Health Plan to our key Massachusetts external partner - the Executive Office of Health and Human Services (EOHHS). Oversees contracts and relationships with that agency, and plays a leadership role across departments, including the broader BMC Health System, WellSense, and its accountable care organizations, in translating and operationalizing regulatory and contractual requirements. The Director also plays a key role in developing and maintaining a constructive relationship with our state partners, manages escalations, and is accountable for contract compliance. The Director, Public Partnerships manages and provides oversight of the Public Partnerships department at BMCHP/Well Sense Health Plan. The department is the hub of the Health Plan’s Massachusetts Medicaid administrative and contract management, and is responsible for the day-to-day oversight of our program performance and compliance with contract terms, requirements, and reporting. Public Partnerships includes a team with significant experience in Medicaid program management, policy analysis, and regulatory affairs.

Requirements

Bachelors Degree or the equivalent combination of training and experience is necessary.
10+ years of related experience in Healthcare, Health Insurance, Managed Care, Government Programs, Government Affairs, Contract Compliance, Project Management
5+ years of leadership experience at the Director level
5+ years managing external stakeholder relationships
Proficient in Microsoft Office.

Nice To Haves

Masters Degree in Public Administration, Public Health, Government Relations, Business, or Law is preferred.

Responsibilities

Serves as the key contact with EOHHS on contract management, deliverables, program matters, requests and escalations.
Leads the analysis and facilitates the implementation of new Medicaid program contracts and amendments, and other new Medicaid program requirements.
Oversees ongoing contract deliverables and end-to-end program requirements of our Medicaid program.
Collaborates extensively with multiple departments to analyze issues, propose solutions, and develop implementation strategies that take into account the regulatory and operational complexities of the Medicaid programs, as well as the needs of members and providers.
Manages complex program procurements, and frequent program audits.
Oversees the management, submission, and control of all Medicaid program reporting.
Leads and develops the Massachusetts Public Partnerships team.
Serves as the Health System’s top expert and thought leader on the Medicaid contracts.
Leads the analysis of Medicaid program requirements, helping translate contract and other requirements into efficient member- and provider-centric solutions. Facilitates or leads implementation of those requirements, in coordination with other business areas. Provides ongoing guidance to departments to ensure compliance and responsible stewardship of the programs.
Represents the Health Plan at meetings and negotiations with EOHHS.
Brokers relationships between Health Plan subject matter experts and EOHHS/DHHS staff.
Oversees the organization, management, quality, and control of all regulatory reporting. Works with departments across the Health Plan on understanding, interpreting and meeting reporting requirements.
In collaboration with the Compliance Department, oversees development of and compliance with corrective action plans as needed.
Oversees urgent state requests and escalations, such as member issues provider complaints, and data requests and in helping to address those incidents, promotes a culture of root cause analysis and “upstream” problem-solving.
Oversees procurement efforts by monitoring, writing, organizing, and submitting responses to RFIs, RFPs, RFRs relating to Medicaid programs and other public programs as needed.
Communicates and collaborates across departments (including the broader BMC Health System and our affiliated ACOs), and all levels of the organization. Must effectively translate complex topics; develop an expert understanding of the Health System’s people, processes and systems; support others in achieving their goals; and exert influence to get things done.
Monitors and analyzes local, regional and national regulatory and Medicaid program design developments with the goal of ensuring organizational compliance and competitive positioning.
Collaborates outside the organization, including with trade groups and other Medicaid plans.