Quincy , MA 02170
The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life.
Summary Job Description
The Community Partners and CSA Account Manager will be a core member of the Community Partners and Social Services Integration team and will report directly to the Community Partners Administration Lead. The position will also work closely with Children's Behavioral Health Initiative unit within the Office of Behavioral Health. The Community Partners Account Manager will be responsible for overseeing communication and managing MassHealth's relationship with a caseload of Community Partners (CPs) and Community Service Agencies (CSAs), with a particular focus on managing these organizations' compliance with and performance under their contracts and will assist the Community Partners Administration Lead and the Director, Community Partners and Social Services Integration with coordinating other key implementation needs. The Community Partners Program Team will be primarily responsible for change management and performance improvement and the Community Partners Account Manager will be responsible for working with CPs and CSAs to improve quality scores, coordination and integration of care and effectiveness of investments
Background on MassHealth Reform and the Accountable Care Organization Program Team:
MassHealth's 1115 demonstration provides an opportunity to emphasize value in care delivery and better meet members' needs through more integrated and coordinated care. To fund the changes to the delivery system, Massachusetts is partnering with the federal government in a Delivery Service Reform Incentive Payment (DSRIP) program. A principal element of the DSRIP Program is implementation of the statewide MassHealth Accountable Care Organization (ACO) program. ACOs are provider-led organizations that are held contractually responsible for the quality, coordination and total cost of members' care. The DSRIP program will utilize four models of integrated care in the MassHealth program: Medicaid Managed Care Organizations (MCOs), Primary Care Accountable Care Organizations (Primary Care ACOs); Accountable Care Organizations administered by Managed Care Organizations (MCO-Administered ACOs) and Accountable Care Partnership Plans.
A major goal of DSRIP is to strengthen linkages between health care providers, including behavioral health (BH) and long term services and supports (LTSS) providers, and support Members with high BH and LTSS needs and their families to help them navigate the system of care in the Commonwealth. To support these members, a key element of the DSRIP Program is the Community Partner (CP) program. The DSRIP program will utilize two models of CPs: Behavioral Health Community Partners (including Community Service Organizations) and Long Term Services and Supports Community Partners. The goal of the Community Partners program is to support and coordinate services across the continuum of care for members in the Commonwealth with significant Behavioral Health and Long Term Services and Supports needs. Community Partners (including CSAs, which will serve as Community Partners for members under 21) will partner with ACOs and MCOs to facilitate integration of Members' care, including medical, Behavioral Health, social, Long Term Services and Supports, and other needs.
MassHealth has designed its overall payment reform and care delivery strategy, and further information on these reforms can be found on MassHealth's Innovations website here: http://www.mass.gov/eohhs/gov/commissions-and-initiatives/healthcare-reform/masshealth-innovations/masshealth-restructuring-updates.html.
CSAs are currently existing organizations which provide services to MassHealth members under 21 as part of MassHealth's Children's Behavioral Health Initiative (CBHI), and which will be eligible for DSRIP funding, and which will have associated accountability requirements.
Over the course of the next year, MassHealth's Community Partners Program Team will conduct procurements and contracting efforts for each Community Partner (including CSAs), assist key implementation leads with significant systems and operational projects, directly manage Community Partners and their performance, revise the Community Partners models' design in response to implementation realities and manage change at scale.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
Supporting the CP and CSA models' implementation, including:
Working directly and comfortably in a matrix environment with personnel throughout the agency to serve as a resource and authority on Community Partners model design and work plan.
Work directly and comfortably with a caseload of CSAs to support contracting, implementation and program management
Collaborating with the Director of Community Partners and Social Service integration and the Community Partners Program Team on the Community Partners model design and implementation work plans. For CSAs, additionally participating as a member of the CBHI team responsible for CSA operations.
Providing expertise on support available to CPs and CSAs provided through the DSRIP program.
Developing and maintaining positive partnerships with contracted CSAs and CPs in order to:
Assure Community Partners (including CSAs) are meeting capacity for required supports specified in the CP or CSA DSRIP contract.
Assure Community Partners (Including CSAs) are meeting contract provisions for performing CP supports.
Assure Community Partners (Including CSAs) are meeting deliverables for infrastructure investments.
Establish and follow clear, detail-oriented, well documented processes for tracking and triaging issues.
Assure high quality of data entered into contracting databases related to contract specifications and terms and completeness of all contracting processes related to Community Partners and CSAs.
Serve as a resource to Community Partners and CSAs to improve their performance under the CP and CSA contracts, including collaboratively investigating performance issues, conducting site visits and other forms of information-gathering, developing and recommending improvement plans, and process managing Community Partners' and CSAs' work plans for performance improvement. This monitoring will require travel to CPs and CSA providers throughout the state.
This position will also spend a portion of their time working within the Children's Behavioral Health Initiative (CBHI) unit of the Office of Behavioral Health at MassHealth (OBH) as a member of the team of overseeing the performance of the CBHI program. Responsibilities will include the following:
CBHI program development
Quality Management, including development of training and technical assistance to support Quality Improvement aims,
Oversight of Managed Care Entities and Accountable Care Organization's implementation and management of CBHI,
Site visits to provider agencies and other CBHI provider meetings as required.
Develop strong collaborative relationships with ACO Account Managers to ensure effective communication, provide support for conflict resolutions with ACO and MCOs and escalate issues and concerns as appropriate.
Develop strong collaborative relationships with the Office of Behavioral Health at MassHealth and the CBHI team
Develop strong collaborative relationships with other relationship managers from MassHealth, sister agencies, and Managed Care Entities who work directly with many of same providers who are contracted as CSAs and CPs in the delivery and coordination of MassHealth covered services.
Establish and follow clear, detail-oriented, well documented processes for tracking and triaging issues, including deferring to appropriate program or network managers regarding MassHealth issues not specifically pertaining to the terms of the CSA and CP contract.
Work collaboratively with other MassHealth units, such as the Office of LTSS, and MassHealth Providers and Plans program staff in coordinating efforts, including stakeholder engagement and communications related to the Community Partners program.
Prior work experience in a contract management role or experience working in BH or LTSS provider setting.
Knowledge of Children's Behavioral Health services, especially Systems of Care service models and high fidelity Wraparound services.
Demonstrated experience working in a matrix environment.
Structured and process-oriented thinker with a strong interest in healthcare policy, particularly payment reform.
Confident taking ownership of work streams with high-level direction and guidance, and producing proposed plans of action in a self-driven manner.
Active and facilitative presence in meetings. Willing and able to provide structure and tight process management. Able to prioritize listening and able to draw out participation from key people in a meeting.
Strong verbal communicator with the professionalism and confidence to represent MassHealth in managing important CSA and CP relationships.
Collaborative approach to problem-solving and performance improvement.
Experience managing implementation or performance improvement projects, including producing work plans and managing to them.
Willingness and ability to work as a collaborative team player in a face paced environment.
Fast learner with dedication to the subject area. Willing and able to put in the time and effort to master a complex set of reform and payment models. Ideally, should have a strong background in related subject matter i.e., alternative payment models, healthcare payment reforms, managed care reforms, accountable care models, integration of care, etc.
Strong skills in PowerPoint and Excel. Ideally, should be able to produce well-structured, visually pleasing exhibits in the former and build/manage work plans and moderately advanced models (e.g., multi-tab financial models, pivot tables, etc.) in the latter.
Desire to take long-term ownership of large and important content areas and work streams.
Masters Degree preferred.
Based on assignment, possession of a current and valid Massachusetts Class D Motor Vehicle Operator's license or the equivalent from another state may be required.
A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit http://www.mass.gov/hhs/cori
Education, licensure and certifications will be verified in accordance with the Human Resources Division's Hiring Guidelines
Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth's website.
For questions, please contact the CYF Office of Human Resources at
1-800-510-4122 and select option #2
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) four (4) years of full-time or, equivalent part-time, professional, professional internship, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management or (B) any equivalent combination of the required experience and substitutions below.
I. A certificate in a relevant or related field may be substituted for one (1) year of the required experience.
II. An Associate's degree in a related field may be substituted for one (1) year of the required experience.
III. A Bachelor's degree in a related field may be substituted for two (2) years of the required experience.
IV. A Graduate degree in a related field may be substituted for three (3) years of the required experience.
V. A Doctorate degree in a related field may be substituted for the required experience.
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.