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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.
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 at 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 welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Director, LRAC serves as Mass General Brigham Health Plan's Government Programs Compliance Officer and plays a crucial role in managing an effective compliance program for the Medicaid, Medicare Advantage (MA), One Care and Senior Care Options lines of business. This role requires a deep understanding of the Medicare Advantage and Medicaid compliance landscapes, healthcare regulations, and a strong background in healthcare management.[SR1.1]
Responsible for managing regulatory compliance, and overseeing risk management initiatives. This position involves collaboration with various departments to ensure adherence to healthcare laws, regulations, and ethical standards.
Essential Functions
-Develop and implement the annual Medicaid, Medicare Advantage, and Duals Compliance Program (Government Programs Compliance Program) and workplans, ensuring compliance with regulatory requirements, optimizing plan compliance performance, and coordinating with various teams to enhance the overall quality of care and member satisfaction
-Implement and lead external auditing and internal monitoring activities of the Government Programs Compliance Program, including CMS and EOHHS audits as well as the monitoring and auditing of vendors. Ensure engagements are completed objectively, professionally, and in accordance with industry audit standards.
-Manage and report an annual evaluation on the Government Programs Compliance Program and present to the Executive Committee and Board of Directors.
-Work collaboratively with department heads to develop, update, and enforce policies and procedures to ensure compliance with legal and regulatory requirements.
-Identify and assess areas of compliance risk for the organization and work with the business to develop corrective action plans.
-Develop and/or ensure internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct.
-Complies with all policies and procedures
-Performs other duties as assigned
Qualifications
Education

• Bachelor's required; Master's degree preferred

Experience

• At least 8-10 years of Medicare health plan compliance management experience required
• Knowledge of a Medicare Advantage plan is highly preferred
• At least 3-5 years of management experience required

Knowledge, Skills, and Abilities

• Strong knowledge of federal, state, and local healthcare regulations, such as Health Insurance Portability and Accountability Act , Medicare/Medicaid rules, and Joint Commission standards.
• Familiarity with accreditation processes and standards.
• Excellent leadership, communication, and interpersonal skills to effectively collaborate with multiple stakeholders and teams.
• Analytical and problem-solving abilities to identify compliance risks and develop effective solutions.
• Ability to maintain confidentiality, exercise good judgment, and demonstrate ethical conduct.

Additional Job Details (if applicable)
Working Conditions

• This is a hybrid role that requires an on-site presence at the office in Assembly Row, Somerville roughly once per month

Remote Type
Hybrid
Work Location
399 Revolution Drive
Scheduled Weekly Hours
40
Employee Type
Regular
Work Shift
Day (United States of America)
Pay Range
$124,342.40 - $180,897.60/Annual
Grade
9
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:
8925 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.