Job Description
Steward Health Care Network (SHCN) takes pride in its community-based care model, which drives value-added tools and services to our communities, patients, physicians, and hospitals across the continuum of care.
In addition, Steward Health Care Network promotes care coordination and collaboration within the network in order to provide high-quality, efficient care to patients.
With Steward in the community, all residents can be sure that there is a world-class doctor close to where they live.
The network is also responsible for the implementation and execution of our managed care contracts, medical management services, quality improvement programs, data analysis, and information services.
Position Purpose: The Director of Medicaid Accountable Care Organization provides leadership and day-to-day operational oversight of Steward’s Medicaid ACO program.
This role is also responsible for the planning and implementation of health plan development-related activities.
Grows and directs the Medicaid ACO program, including:
Prepares financial opportunity and risk analysis to recommend program objectives to senior leadership
Directs budget development, contract management, and financial reporting related to the Medicaid ACO program
Collaborates with all necessary departments (Care Management, Performance, Analytics, Finance, IT, Strategy, and Policy) to resolve complex issues related to the initiatives and program
Creates, interprets, and disseminates information across multiple internal and external stakeholders
Ensures compliance with all Medicaid ACO Agreement requirements and applicable laws, rules, and regulations
Leads key governance meetings related to Medicaid.
Evolves the Medicaid ACO program to incorporate substantial health plan operations.
This includes:
Direct health plan development activities, such as defining business requirements and partnering with health plan team to implement health plan functions
Provide direction to the Project Implementation Team within the Project Management Office on health plan development priorities, and oversee project status reports and resource management
Manage relationships with state regulators, including the Executive Office of Health and Human Services and the Division of Insurance.
Review and approve all regulatory-facing deliverables prior to executive sign-off and submission
Identifies opportunities to continually innovate with Medicaid ACO population to achieve performance outcomes, including:
Identifies key tactical and operational initiatives and ensures such initiatives are professionally project managed to meet performance objectives
Designs models and performs ad hoc analysis for the purpose of understanding the historical and future performance of initiatives
Monitors, interprets, and reports on changes in performance, market trends, health care delivery systems, and legislative initiatives that impact program efforts (e.g., CMS ACO regulations, Massachusetts Health Reform)
Coordinates advocacy and lobbying efforts to drive Medicaid ACO program changes
Identifies opportunities in other Steward markets for potential participation in additional Medicaid ACO programs
Other duties as assigned
Education / Experience / Other Requirements
Education:
Bachelor’s degree required
Master’s degree in health care related field strongly preferred
Years of Experience:
Minimum of 5 years of experience in related roles, including large program implementations
Specialized Knowledge:
Possesses strong background in health plan business, program, and operational functions
Creative, flexible, self-motivated, professional able to navigate complex, matrixed environments
Demonstrates critical thinking skills
Proven excellent written and verbal communication skills.
Ability to present information to small and, at times, large audiences
Possesses excellent time management skills with proven ability to effectively manage multiple tasks and priorities at one time
Demonstrates knowledge of managed care concepts for various health plan and capitated programs
Collaborates with multiple providers to provide quality and cost-effective care for risk members.
Accepts flexibility in work schedule willingly.
(e.g., periodic early morning or evening meetings)
Requisite poise, judgment, and trustworthiness to represent Steward to internal and external groups
Maintains information in a confidential manner according to policy
Strong proven leadership and experience with the MassHealth program (i.e., FFS, PCC, MMCO, etc.); network development and ACO experience is highly valued
Strong interpersonal skills and ability to interact positively with a wide range of constituents
Strong organizational and project management skills including development of project parameters, goals, and timelines and outcome measurement
Analytic skills to collect information from diverse sources and summarize the information and data in order to solve problems
Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary
Ability to work both independently and within a team environment and a multi-dimensional environment
Possesses sound judgment ability to plan and initiate new activities consistent with achieving service excellence
Some travel may be necessary
Steward Health Care is an Equal Employment Opportunity (EEO) employer.
Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Location: Steward Health Care Network · 1301.72330 Steward Health Care Network
Schedule: Full Time, Day Shift, Mon-Fri