BFT - Program Director, Duals Implementation (Temporary)

Site: The General Hospital Corporation

 

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

 

 

Job Summary

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.

The Program Director, Duals Implementation (Temporary) will support the Clinical department in achieving operational readiness for the launch of Mass General Brigham Health Plan’s Dual-Eligible Special Needs Plan (D-SNP), including One Care and Senior Care Options (SCO). This role will provide targeted, hands-on support across Coordinated Care, Utilization Management, and Appeals & Grievances, documenting compliant workflows, managing cross-functional dependencies, and supporting readiness validation in alignment with CMS, MassHealth, and Model of Care requirements.

This temporary position is expected to start in July and go through November 2025, with the possibility of extension based on organizational needs and performance.

 

Qualifications

Principal Duties and Responsibilities:

Support development of core Clinical functions for D-SNP readiness

• Partner with Clinical leads across identified areas to facilitate design and documentation of end-to-end workflows for areas including Coordinated Whole Health Care, Utilization Management (UM), and Appeals & Grievances (A&G)
• Ensure workflows align with Model of Care requirements and product goals, including risk stratification, care team assignment, individualized care planning, and coordination with external groups
• Integrate UM and A&G processes with Coordinated Care workflows, providing guidance on documentation standards that support regulatory reporting and audit readiness
• Provide ad hoc support for development of supporting materials such as standard operating procedures, job aids, scripts, and reporting templates in alignment with CMS and MassHealth requirements

Coordinate cross-functional dependencies

• Identify and monitor operational and system dependencies that impact Clinical implementation workstreams
• Collaborate with cross-functional teams (e.g., IT, Compliance, Product) to gather inputs, confirm handoffs, and validate workflows
• Facilitate Clinical stakeholders growing competencies in dual eligible products (e.g. offer translation and support to identify appropriate use of information, decisions, and resources needed to complete their deliverables)

Project execution and delivery support

• Inform implementation tracking by sharing key updates that support monitoring of progress, risks, and outstanding decisions across Clinical workstreams
• Partner with Clinical and state governments leadership to identify and resolve cross-functional risks impacting D-SNP launch readiness

• Bachelor’s degree required, advanced degree in Public Health, Health Administration, Nursing, or related field preferred
• 5-7 years of experience in health plan operations, including D-SNP (One Care and SCO)
• Experience with D-SNP Model of Care implementation preferred
• Knowledge of CMS and state level requirements related to clinical operations
• Strong organizational and project management experience required, preferably in a healthcare setting
• Proficiency in Microsoft Office Suite

Skills/Abilities/Competencies:

• Deep understanding of clinical operations within a health plan, including care management, utilization management, and appeals & grievances
• Dual eligible subject matter expertise or corresponding expertise in Medicare or Medicaid clinical requirements and operations.
• Strong ability to interpret and apply CMS, MassHealth, and Model of Care requirements in a practical, operational context
• Skilled in designing and documenting workflows, policies, and procedures that support audit readiness and regulatory compliance
• Strong project execution skills, with the ability to track complex workstreams, manage interdep