ACO Program Specialist, Public Plans Job Opening

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Job Summary

The core business model of Tufts Health Plan’s Massachusetts Medicaid (MassHealth) product features strategic partnerships with provider accountable care organizations (ACOs). Reporting to the Manager of ACO Strategy and tasked with managing the ACO partnerships and facilitating smooth operations of the program, the ACO Program Specialist improves the level of collaboration and contributes to the goal of overall program success as measured by P&L performance, growth, innovation, quality outcomes, and compliance, among other indicators.
Key success factors of the role include tactical problem-solving skills, organizational skills, strong communication and business execution, curiosity about healthcare innovation, and effective collaboration with internal and external stakeholders.

Job Description

• ACO Business Process Management and Compliance

Under the direction of management, the program specialist is responsible for ensuring the fulfillment of essential program requirements and managing regular cadence of the partnership, which include:

• Plan board and committee meetings, develop agendas and materials with ACO counterparts and support from internal colleagues.
• Ensure timely and accurate submission of required deliverables to the ACO and state agencies in accordance with applicable regulatory or contractual obligations.
• Attend internal and external meetings related to ACO partnerships and triage information and synthesis to the appropriate stakeholders
• Participate in projects within the scope of ACO strategic roadmaps

• ACO Relationship Development and Management

As the day-to-day point person of an ACO relationship, and under the guidance of management, the program specialist is responsible for the intake, triage, and resolution of operational issues with the appropriate support, and promoting collaboration between the two organizations. Specifically, the specialist will:

• Respond to operational issues that come up from the ACO partners and appropriately triage them to the right internal departments for resolution. Ensure the issues are resolved or otherwise escalated as needed. Maintain coordination and communication with internal and external stakeholders throughout the process
• Build and maintain strong and trusting relationships with both ACO partners and the internal stakeholders that support the ACO program
• Plan and facilitate regular and ad-hoc touch-points with key ACO contacts, exercising judgment to include appropriate internal stakeholders and subject matter experts

• ACO Performance Management Support

A principal measurement of ACO success is its performance against defined total cost of care and quality targets. As such, an essential responsibility of THP via the partnership is to support ACOs’ performance improvement efforts. The specialist’s role in this work will be to:

• Work closely with THP enterprise functions to ensure accurate and timely production of data-driven reports, manage follow-up efforts to pursue needed analytics and advance performance opportunity insights
• Demonstrate interest in and develop an understanding of each ACO's performance against defined targets, which include cost, utilization, quality and other key indicators
  • Collaborate with ACO partners and internal departments to act on identified performance improvement opportunities in alignment with the broad strategic plan

Requirements

EDUCATION:

• Bachelor’s Degree

EXPERIENCE:

• 3-5 years of experience with a proven track record of success in health care environment; project management background preferred

SKILL REQUIREMENTS:

• Ability to take up ambiguous or complex operational problems and facilitate problem-solving effectively using internal resources and processes
• Ability to prioritize, organize and ensure follow through on multiple deliverables, simultaneously
• Ability to work effectively across functions and with people at all levels, including clinicians
• Understanding of the payer-provider industry; experience with government health care programs valued
• Excellent communication skills, both oral and written
• Ability to ensure accuracy of data reports

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:

• Must be able to travel within the Boston metro area to ACO locations periodically

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

What we build together changes our customer's health for the better. We are looking for talented and innovative people to join our team. Come join us!