Site: Mass General Brigham Health Plan Holding Company, Inc.

 

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.

 

Replacement for terminated staff

 

Job Summary

Responsible to lead contract team in the interpretation and formulation of provider contracts, and supports team members in understanding policies, procedures, methods, operating practices, and performance standards. This role would work with Configuration, Claims, and Finance to ensure contract terms are loaded correctly. Facilitates effective implementation of contract responsibilities within program objectives and requirements. Reviews and resolves the most complex issues and contracts. Advises management of contractual rights and obligations and provides interpretation of terms and conditions.

• With appropriate support, serves as the lead negotiator for Commercial, Medicare Advantage and Medicaid ACO contracts, including but not limited to fee-for-service, shared savings and risk-based agreements for hospitals and health care systems and large provider groups.
• Obtains necessary analytical information to determine effective contract negotiation strategy and approach.
• Evaluates, negotiates, and recommends approach and develops comprehensive proposals to be made to ensure that newly negotiated, and existing provider contracts meet financial requirements and achieve corporate initiatives and objectives.
• Ensures contract language and terms are consistent with organizations desired outcomes.
• Works independently and diligently throughout the contracting process and in the development and maintenance of complex provider relationships to ensure appropriate contract performance. This includes detailed financial analysis to identify medical cost improvement opportunities, development of contracting approach and action plans, identification of appropriate provider groups for risk-based contracts and their successful negotiation and implementation.
• Serves as resource within department and organization. Represents Provider Contracting as necessary on projects, committees, etc.
• Maintains and shares knowledge of the singularities around regulatory, business, and political environments that can and will impact contract discussions.
• Hold self and others accountable to meet commitments.
• Ensures diversity, equity, and inclusion are integrated as a guiding principle.
• Persists in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Builds strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

 

Qualifications

Bachelor’s Degree plus 5-7 years of related experience required. Master’s Degree plus 5-7 years of related experience preferred.Knowledge of the complexities of the local MA marketExperience with Commercial, Medicare, Medicaid, and D-SNP lines of busienss

Knowledge, Skills, and Abilities

Large system, hospital and physician network contracting experience.Outstanding written and oral communication skills; strong presentation skills                                                     Experience with the complexities and mechanics of provider contracting.Proven successful negotiation experience with complex and highly leveraged providers, superior financial, analytical, and verbal and written communication skills.Proven ability to work efficiently and effectively with analytical tools, software and systems.Proven leadership, decision-making and consensus and relationship building skills.Outside of organization, experience working with Directors of Managed Care, Contracting staff, CFOs and Executives                                                                     

 

Additional Job Details (if applicable)

Working Conditions

Remote position, with occasional travel to the Mass General Brigham Health Plan offices located in Somerville, Massachusetts

 

Remote Type

Remote

 

Work Location

399 Revolution Drive

 

Scheduled Weekly Hours

40

 

Employee Type

Regular

 

Work Shift

Day (United States of America)

 

Pay Range

$78,000.00 - $113,453.60/Annual

 

Grade

7

 

At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

 

EEO Statement:

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

 

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.