Health Plan Administration Contract Manager

MassHealth is Massachusetts’s Medicaid and Children’s Health Insurance Program (CHIP). MassHealth provides comprehensive, affordable health care coverage for over two million low-income Massachusetts residents, including 40% of all Massachusetts children and 60% of all residents with disabilities. MassHealth’s mission is to improve the health outcomes of our diverse members and their families by providing access to integrated health care services that sustainably and equitably promote health, well-being, independence, and quality of life.  

The Contract Management and Operations (CM&O) team is part of the Office of Accountable Care and Behavioral Health (ACBH) and is tasked with the oversight and management of MassHealth’s Accountable Care Organizations (ACOs), Managed Care Organization (MCOs), Primary Care Clinician (PCC) Plan and the MassHealth behavioral health vendor, the Massachusetts Behavioral Health Partnership (MBHP). The ACOs, MCOs, PCC Plan, and MBHP are responsible for delivering services to ~1.5 million MassHealth members and are key partners in improving health care outcomes and driving innovation. 

ACOs are the central managed care delivery system of MassHealth’s current 1115 Demonstration, which has been a critical tool in enabling Massachusetts to achieve and maintain near-universal health coverage, sustain the Commonwealth’s safety net health system, expand critical behavioral health services, and implement reforms in the way that care is delivered. MassHealth ACOs initially launched in 2018 and 17 new ACOs were launched in 2023. ACOs are provider-led managed care organizations accountable for improving quality of care, member experience, and total cost of care. Since 2018, ACOs have transitioned care for over a million members from a largely fee-for-service system towards a value-based payment model where providers are accountable for managing the health of their membership. 

The Health Plan Administration Contracts Manager will drive towards improved healthcare outcomes for members, robust and high-quality service delivery and streamlined administrative processes by managing relationships and key contact functions with a set of health plans and vendors. The incumbent will ensure the contract compliance of assigned accounts, including the management of audits, response to Centers for Medicare and Medicaid Services (CMS) questions and coordinating with various subject matter expert (SME) teams on the review and approval of submitted reports and other deliverables, supporting various MassHealth workstreams related to the management of the ACO program. The incumbent will work alongside other health plan contract managers and staff from across other offices in MassHealth, such as Enrollment Operations, the Office of Long Term Services and Supports (OLTSS), the Pharmacy Office, etc. to gather information about current initiatives and present findings to ACBH and MassHealth Leadership. 

The Health Plan Administration Contract Manager will be expected to support multiple efforts in a fast-paced, cross-functional work environment, and coordinate workstreams across multiple teams throughout ACBH and the agency. They will need to be attentive to detail and have excellent communication skills.

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

• Manage relationships and key contacts with a set of health plans and vendors, including providing front-line operational support, and customer service for assigned accounts. 
• Ensure the contract compliance of assigned accounts, including handling audits and CMS questions and coordinating with various subject matter expert teams on the review and approval of submitted reports. 
• Support various MassHealth workstreams related to the management of the ACO programs, including care delivery-related performan