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 Senior Vice President, State programs will build and oversee and drive the success of our Medicaid and OneCare and SCO programs, ensuring the delivery of high-quality, cost-effective healthcare services to eligible population. This role is responsible for providing innovative and collaborative leadership guiding an aggressive and profitable growth strategy for Mass General Brigham's Medicaid, OneCare and SCO lines of business. This role has direct responsibility for the Medicaid, OneCare and SCO lines of business, P&L and development and succession execution against its strategies.

This Senior Vice President will function as a subject matter expert and champion through Mass General Brigham's application and implementation process. The Senior Vice President is responsible for managing annual regulatory cycles (once the program is approved), large complex OneCare and SCO related projects as well as strategic business initiatives from the initial evaluation phase through project implementation to meet the business needs of the program. The role reports to the President of the Health Plan and will manage the Medicaid, OneCare and SCO lines of business.

The position leads the organization in developing innovative plans to align organizational objectives and targets. This includes developing and meeting project objectives within established timelines and managing associated risks. The Senior Vice President, State Programs works with consultants, vendors, internal & external customers, subject matter experts, and cross functional teams. Responsibilities include providing periodic updates and reports to leadership. This position will work directly with sponsors and key stakeholders to mobilize and motivate teams. This position is responsible for guiding the direction and approach for the team, resolving conflict, and executing plans with limited information and ambiguity.

The Senior Vice President, State Programs develops strategic plans for the Medicaid, OneCare and SCO lines of business that are in line with Mass General Brigham Health Plan and Mass General Brigham systemwide business strategy which ensures delivery against its mission. The Senior Vice President will be responsible to present to the President and Board of Directors and gain agreement for financial investments and resource allocations that facilitate delivery against the plan. Additionally, this role develops operational plans & timelines to synthesize, organize and execute on objectives and manages a leadership team to deliver on those plans while driving continuous improvement.

Project Management:

• Develop and maintain project plan for Dual eligible program application and implementation efforts.

• Provide frequent updates to duals-related governance structures and Senior Leadership Team related to program status and escalations.

• Develop detailed project work plans for projects involving multiple functional areas and manage projects efficiently to implement solutions to support the company's business needs.

• Conduct business and project planning, issue tracking/ resolution, and overall management of a project teams.

• Work with internal & external customers to understand issues and recommend and vet solutions, resolve conflict, and manage the project objectives & target dates.

• Initiate and facilitate key planning meetings within functional areas or across cross-functional teams.

• Collaborate with stakeholders to define solutions, scope, requirements, business processes, delivery approach and implementation plan parameters.

• Effectively use tools to increase effective brainstorming & decision making amongst project teams.

• Develop workflow & process flow diagrams to help identify improvement opportunities and collaborate with IT for implementing automated solutions.

• Provide project leadership guidance to staff as needed for successful & timely project execution.

• Mentor on effective project management techniques and improving developing behavioral competencies.

Strategy:

• Develop and create, in partnership with the President and executive team, growth and service strategies for Medicaid, OneCare and SCO lines business.

• Demonstrate an articulate, comprehensive vision and an understanding of the challenges and opportunities facing Mass General Brigham Health Plan.

• Ensure that the overall strategy is clear, consistently evaluated and updated regularly.

• Analyze the external market environment and company product portfolio and distribution channels. Review and adapt strategies as appropriate.

• Work with the President and CFO to prepare financial planning assumptions.

• Strategically secure and allocate Medicaid, OneCare and SCO investments - securing funding, prioritization & business plans.

• Define customer experience (including expectations of vendor experience for membership on behalf of Mass General Brigham Health Plan).

Operational Plans:

• Oversee the development of the Medicaid, OneCare and SCO line of business' annual financial operating plans.

• Ensure plans are in place to deliver on the plan.

• Monitor performance against plans and make course adjustments along the way. Responsible for actionable reporting and analysis.

• Drive operating efficiency and effectiveness, ensuring continuous improvement.

Metrics:

• Accountable for delivery against the following metrics: Membership, P&L (MLR and Operating Margin.) These are set each year and monitored for progress.

• Set targets (financial, membership performance, loyalty/retention & satisfaction).

• Utilize data analytics to assess program performance, identify trends, and make data-driven decisions.

• Prepare and present regular reports to executive leadership on the status and achievements of Medicaid, OneCare and SCO lines of business.

Membership:

• Drive the company to achieve and surpass profitable membership goals and related business goals and deliver annual operating plan objectives. Makes course corrections as necessary.

• Develop and clearly articulate a Medicaid, OneCare and SCO growth plan.

• Appraise and evaluate the results of business growth regularly and systematically, making changes as needed to ensure success.

• Set membership forecast & monitoring membership (actual vs budget, performance, drill downs of segments performance.)

Product Development:

• Oversee all Medicaid, OneCare and SCO product development to ensure a strategy and development plan is in place for existing and new Medicaid, OneCare and SCO product lines.

• Bring first to market products that will differentiate and accelerate growth.

• Champion this development and coordinate the efforts of other senior executives amidst competing demands for resources.

Network:

• Work collaborative with the Network Management team regarding the overall network strategy.

• Ensure the depth and breadth of the Medicaid, OneCare and SCO networks to deliver on their strategies, product line promises, quality delivery and financial goals.

• Maintain a relationship with the network, keeping them informed and educated as necessary.

Quality Assurance and Compliance:

• Implement and monitor quality assurance processes to guarantee the delivery of high-quality healthcare services to beneficiaries.

• Ensure compliance with federal and state regulations, staying abreast of changes and proactively adapting program strategies.

Leadership:

• 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 required or the equivalent combination of training and experience, plus 7+ years of related experience.

• MBA or equivalent graduate degree preferred.

• 15+ years of progressive management experience.

• Prior experience working cross-functionally in Medicaid and DSNP (OneCare and SCO plans.)

• Strong project management skills.

• Exceptional communication skills.

• Ability to understand ambiguous problems, help frame issues to cross-functional stakeholders and facilitate discussions to drive to solutions.

• Strong ability to influence without formal authority.

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.