Integrated Care Contract Coordinator

MassHealth’s Integrated Care Team reports directly to the Chief of Long Term Services and Supports and is responsible for MassHealth’s integrated care delivery systems: One Care, Senior Care Options (SCO), and Program of All-inclusive Care for the Elderly (PACE) Organizations.

The Integrated Care Contract Coordinator provides direct support to the Deputy Director of Plan Administration and Oversight to manage day-to-day engagement with, and oversight of, One Care, SCO, and PACE contracts. The Integrated Care Contract Coordinator also provides indirect and ad hoc support to the One Care Program Manager, the SCO/PACE Program Manager, and the Integrated Care Senior Policy Manager for management of the integrated care plans.

Smart, curious, self-motivated individuals skilled in contract, vendor, and program management, effective communication, collaborating in a team environment, and preferably having prior exposure to state or federal program management, managed care, health care programs, or policy are encouraged to apply.

Duties and Responsibilities (these duties are a general summary and not all inclusive):

• Serve as the Key Contact and primary interface for designated integrated care plans.

• Work closely with staff in MassHealth’s Office of Long Term Services and Supports (OLTSS) as well as staff in Eligibility, Operations, Finance, Strategy, Legal, Office of Clinical Affairs, Program Integrity and other MassHealth units to manage contracted entities.

• Develop productive relationships with integrated care plan key contacts and provide technical support and assistance as needed to integrated care plans.

• Handle member and other external inquiries and concerns effectively and with compassion.

• Monitor the performance of integrated care plans to ensure compliance with contractual requirements including, but not limited to, all contractual reporting requirements, grievance and appeals processes, and the resolution of individual appeals, complaints, and denied claims.

• Use quality, financial, and other performance data to monitor and manage assigned integrated care plans toward improved performance and member outcomes.

• Lead or participate in special projects and work groups to promote operational efficiencies that will lead to better experience for members and providers engaged in integrated care programs.

• Recommend and implement management strategies and escalate issues appropriately within MassHealth and to CMS.

• Coordinate the research of answers and issue resolution related to covered benefits, member access to care, and other program related items.

• Review plan marketing material submissions, annual benefits material submissions, audit materials, and other required materials as needed.

• Participate collaboratively in state/federal partnerships, including contract management and program management activities.

• Conduct or participate in training and outreach sessions for integrated care as needed.

• Maintain open lines of communication with internal, external, and interagency stakeholders to ensure ongoing collaboration, coordination, and input.

• Perform other duties as required.

Preferred Qualifications:

·       Program or contract coordination experience in