Director, Public Partnerships

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

The Director, Public Partnerships represents the mission, vision and values of BMCHP/Well Sense Health Plan to our key Massachusetts external partner - the Executive Office of Health and Human Services (EOHHS). Oversees contracts and relationships with that agency, and plays a leadership role across departments, including the broader BMC Health System, WellSense, and its accountable care organizations, in translating and operationalizing regulatory and contractual requirements. The Director also plays a key role in developing and maintaining a constructive relationship with our state partners, manages escalations, and is accountable for contract compliance.

The Director, Public Partnerships manages and provides oversight of the Public Partnerships department at BMCHP/Well Sense Health Plan. The department is the hub of the Health Plan's Massachusetts Medicaid administrative and contract management, and is responsible for the day-to-day oversight of our program performance and compliance with contract terms, requirements, and reporting. Public Partnerships includes a team with significant experience in Medicaid program management, policy analysis, and regulatory affairs.

Our Investment in You:

* Full-time remote work

* Competitive salaries

* Excellent benefits

Key Functions/Responsibilities:

* Serves as the key contact with EOHHS on contract management, deliverables, program matters, requests and escalations.

* Leads the analysis and facilitates the implementation of new Medicaid program contracts and amendments, and other new Medicaid program requirements.

* Oversees ongoing contract deliverables and end-to-end program requirements of our Medicaid program.

* Collaborates extensively with multiple departments to analyze issues, propose solutions, and develop implementation strategies that take into account the regulatory and operational complexities of the Medicaid programs, as well as the needs of members and providers.

* Manages complex program procurements, and frequent program audits.

* Oversees the management, submission, and control of all Medicaid program reporting.

* Leads and develops the Massachusetts Public Partnerships team.

* Serves as the Health System's top expert and thought leader on the Medicaid contracts.

* Leads the analysis of Medicaid program requirements, helping translate contract and other requirements into efficient member- and provider-centric solutions. Facilitates or leads implementation of those requirements, in coordination with other business areas. Provides ongoing guidance to departments to ensure compliance and responsible stewardship of the programs.

* Represents the Health Plan at meetings and negotiations with EOHHS.

* Brokers relationships between Health Plan subject matter experts and EOHHS/DHHS staff.

* Oversees the organization, management, quality, and control of all regulatory reporting. Works with departments across the Health Plan on understanding, interpreting and meeting reporting requirements.

* In collaboration with the Compliance Department, oversees development of and compliance with corrective action plans as needed.

* Oversees urgent state requests and escalations, such as member issues provider complaints, and data requests and in helping to address those incidents, promotes a culture of root cause analysis and "upstream" problem-solving.

* Oversees procurement efforts by monitoring, writing, organizing, and submitting responses to RFIs, RFPs, RFRs relating to Medicaid programs and other public programs as needed.

* Communicates and collaborates across departments (including the broader BMC Health System and our affiliated ACOs), and all levels of the organization. Must effectively translate complex topics; develop an expert understanding of the Health System's people, processes and systems; support others in achieving their goals; and exert influence to get things done.

* Monitors and analyzes local, regional and national regulatory and Medicaid program design developments with the goal of ensuring organizational compliance and competitive positioning.

* Collaborates outside the organization, including with trade groups and other Medicaid plans.

Supervision Exercised:

* Manages 3-5 direct reports. Potentially manages 5-10 indirect reports.

Supervision Received:

* General direction is received on a weekly basis and as needed.

Qualifications:

Education:

* Bachelors Degree or the equivalent combination of training and experience is necessary.

Preferred/Desirable:

* Masters Degree in Public Administration, Public Health, Government Relations, Business, or Law is preferred.

Experience:

* 10+ years of related experience in Healthcare, Health Insurance, Managed Care, Government Programs, Government Affairs, Contract Compliance, Project Management

* 5+ years of leadership experience at the Director level

* 5+ years managing external stakeholder relationships

Certification or Conditions of Employment:

* Pre-employment background check

Competencies, Skills, and Attributes:

* Committed to the mission, vision and values of the BMC Health System.

* Ability to successfully manage highly complex contracts and projects.

* Detail-oriented, customer-service oriented, goal-oriented.

* Skilled communicator.

* Ability to build and lead teams.

* Strong analytical and quantitative skills.

* Ability to manage multiple priorities.

* Pro-active, flexible, collaborative, curious and positive.

* Proficient in Microsoft Office.

Working Conditions and Physical Effort:

* Ability to travel within Massachusetts as needed.

Compensation Range

$120,500 - $175,000

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.

Note: This range is based on Boston-area data, and is subject to modification based on geographic location.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees.