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Fallon Health Senior Director, Medicaid Relationship Management in Worcester, Massachusetts

Overview

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

The Senior Director is the lead executive responsible for managing Fallon Health’s relationships with multiple current ACO provider partners and developing new provider partnerships. The Senior Director must have a demonstrated ability to build and maintain positive relationships with business partners. The candidate needs to be comfortable interacting with executive leadership of external entities and continually gauging satisfaction with Fallon Health. S/he must effectively position Fallon Health to maintain partnerships with new ACOs and attract new provider partners. S/he must prioritize and effectively advocate for the needs of current and prospective provider partners within Fallon Health. This role will represent Fallon Health in reprocurement discussions with current and prospective provider partners and in the ACO Joint Governance Committee structure with each contracted provider partner. The Senior Director is responsible for working with each assigned ACO partner to develop financial and performance targets; develop and implement performance improvement initiatives; continually monitor performance; and regularly report results to partners and Fallon Health executive leadership. The Senior Director will partner closely with the Senior Director of ACO Product Management, the ACO Medical Director, the appropriate Provider Contracting managers, and internal Fallon Health departments to resolve operational or clinical issues from the provider partners.

Responsibilities

ACO Growth

  • Lead efforts to successfully contract with selected existing and/or prospective ACO provider partners.

  • With provider partners, lead efforts to successfully respond to MassHealth reprocurement RFP.

  • In partnership with the Senior Director of ACO Product Management, ensure the successful and timely implementation of ACO partnerships.

  • Participate in strategy development and ongoing planning and analysis, including prioritization of target partners for growth.

ACO Governance

  • Co-lead ACO Governance with executive leadership of selected provider partners.

  • Maintain ongoing communication with provider executive leadership, identifying issues that require executive attention and framing decision points for the Governance committee.

  • With the support of ACO Product Management staff, ensure that all ACO governance decisions are appropriately documented and that all regulatory and contractual requirements are satisfied.

Additional

  • Building long-lasting, mutually beneficial relationships with executive leadership and key contacts at ACO provider partners.

  • Build strong relationships with key MassHealth leadership and staff.

  • Develop expertise in MassHealth contractual requirements and financial models and serve as a resource for provider partners. Educate and inform clients about new state regulations and requirements. Intervene as necessary to ensure compliance.

  • Act as liaison between Fallon and ACO Partners on day to day issues surrounding the ACO. Remain in frequent contact with the providers to understand their needs.

  • Build strong relationships with internal departments to create a better customer experience. Support and solve problems for clients by understanding and exceeding their expectations.

  • Partner closely with the Senior Director of ACO Product Management to resolve any operational issues raised by the ACO Partners.

  • Partner closely with the Medical Director to resolve any issues related to the model of care. Work closely with the Medical Director and provider partner to identify opportunities for improved performance in utilization, quality and health equity.

  • Partner closely with the Actuarial department to understand ACO financial performance and effectively communicate results to partners and to senior leadership at Fallon Health.

  • Partner closely with Network Development and Management to understand the contractual terms with each provider partner.

  • Partner with Medical Economics to deliver timely, insightful and actionable information to ACO provider partners. Develop expertise in understanding of data and reports and effectively explain their content to partners as needed.

  • Partner with Risk Adjustment to deliver timely, insightful and actionable information to ACO provider partners. Develop expertise in understanding MassHealth risk adjustment methodology and work with Risk Adjustment to ensure that partners have the information and support they need to accurately capture risk scores for members.

Qualifications

  • 10-15 years’ progressive leadership experience in managed care required.

  • Preferred experience includes extensive experience building positive relationships with senior executives externally and internally.

  • Ideal would be knowledge of plan operations, finance, medical economics, product implementation, marketing and product management.

  • Looking for an individual committed to health equity and improving health outcomes and experience for the Medicaid population.

  • This role will leverage excellent presentation and interpersonal skills

  • Bachelors’ degree required, master’s degree in management or related field strongly preferred.

JT18

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Location US-MA-Worcester

Posted Date 2 months ago (11/29/2021 3:05 PM)

Job ID 6610

# Positions 1

Category Medicare Medicaid Programs

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