The Deputy Program Integrity Director is a policy, people and operational leader within the Program Integrity Unit of MassHealth. The Program Integrity Unit is a highly strategic function within MassHealth that sets the standard for financial stewardship. Program Integrity leads and coordinates efforts related to ensuring Commonwealth resources are utilized appropriately in support of MassHealth members. The team is led by the Director of Program Integrity, who reports to the Deputy Medicaid Director, and consists of 10 internal staff members and dozens of contractors ($50M+ in annual contract value). MassHealth currently works in a hybrid in-person and virtual environment, with headquarters located in downtown Boston.
Under the general direction of the Director of Program Integrity, the Deputy Program Integrity Director is responsible for leading MassHealth’s efforts to control fraud, waste and abuse (“FWA”) across the agency’s programs. The Deputy Director has two primary responsibilities: 1) ensuring that Managed Care Organizations who contract with MassHealth are appropriately utilizing state funds, and 2) enabling the operational effectiveness of Program Integrity across all its sub-teams. This role is analytical, highly strategic, and cross-functional in nature. The role would be a great fit for individuals looking for leadership and management opportunities that balances accountability towards objective metrics and delivering on overall functional success.
The Deputy Director will focus on the identification, development and implementation of innovative program integrity solutions to achieve the agency’s dual priorities of maintaining high-quality member care and controlling spending growth. This includes new approaches to mitigating FWA in managed care, with a strong focus on using data more effectively to drive performance and millions of dollars in savings for the Commonwealth. This position will focus on predicting, detecting, preventing, and deterring inappropriate payments to healthcare providers. The Deputy Director is ultimately accountable for executing successful projects that have meaningful impact on MassHealth members’ lives and/or generate material savings to the Commonwealth.
The Deputy Director position involves multidimensional engagement with internal and external stakeholders, including MassHealth members, advocates, providers and payers, as well as other state and federal entities such as the Centers for Medicare and Medicaid Services, State Auditor’s Office, and Office of Inspector General. The position requires a combination of skills in policy, operations, strategy, business/program areas, analytics and technical expertise. The Deputy Director’s responsibilities will intersect with a cross-functional team including representatives from MassHealth program, policy, legal, and IT units to develop work plans, conduct analysis, and propose solutions to the MassHealth executive team. It would also involve collaboration to develop of contractual enhancements, regulation and policy changes, and new operational processes to address issues identified.
Duties and Responsibilities (these duties are a general summary and not all inclusive):
- Lead program integrity oversight of managed care entities’ controls against fraud, waste and abuse, including identification and implementation of best practices, reporting compliance, claims data analysis, development of key performance indicators, and interface directly with MassHealth’s managed care entities.
- Identify new Program Integrity initiatives to drive savings, cost avoidance, and/or revenue. Work cross functionally, including with data & analytics and program teams, to generate buy-in, build implementation plans focusing on policy and process changes, and execute deliverables.
- Lead and manage cross-functional teams on baseline projects and new initiatives, including representatives from program teams, policy, strategy, and legal to execute initiatives.
- Build operational excellence, including development, maintenance, and implementation of work plans and standard operating procedures for key program integrity initiatives.
- Maintain program integrity budget tracker. Work with the Program Integrity Director to set annual goals for cost savings and communicate quarterly status updates across teams to executive team.
- Respond to urgent agency, legislative or regulatory priorities as identified.
Preferred Qualifications:
- Excellent analytical and problem-solving skills.
- Excellent MS Excel and PowerPoint skills.
- Excellent communication skills.
- Excellent manager and developer of skills.
- Entrepreneurial mindset; ability to identify opportunities and develop solutions with minimal guidance.
- Experience analyzing large data sets and/or overseeing analytics teams.
- Comfort with working under high pressure and tight time constraint.
- Ability to provide structure and process management to projects.
- Knowledge of CMS and MassHealth regulations.
- Strong interpersonal skills.
- Passion for public service.
- Experience in healthcare strongly preferred.
- Experience with claims data or other related analytical experience strongly preferred.
- Demonstrated performance in strategic planning and analysis.
- Experience leading high-profile projects and processes with accountability to senior leadership.
- Demonstrated entrepreneurship and intellectual curiosity.
TO APPLY:
Please upload both Resume and Cover Letter for this position when applying.
About MASSHEALTH:
To improve the health outcomes of our diverse members and their families by providing access to integrated health care services that promote sustainable & equitable health, well-being, independence and quality of life.
For more information about our agency and programs please visit:www.mass.gov/masshealth
Pre-Offer Process:
A criminal and tax and 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 visithttp://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.
If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete theReasonable Accommodation Online Request Form.
For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #4.
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) six (6) years of full-time or, equivalent part-time, professional, administrative, supervisory, or managerial experience in business administration, business management, public administration, public management, clinical administration or clinical management of which (B) at least two (2) years must have been in a project management, supervisory or managerial capacity or (C) any equivalent combination of the required experience and substitutions below.
Substitutions:
I. A certificate in a relevant or related field may be substituted for one (1) year of the required (A) experience.
II. A Bachelor's degree in a related field may be substituted for two (2) years of the required (A) experience.
III. A Graduate degree in a related field may be substituted for three (3) years of the required (A) experience.
IV. A Doctorate degree in a related field may be substituted for four (4) years of the required (A) experience.
Comprehensive Benefits
When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future.
Want the specifics?Explore our Employee Benefits and Rewards!
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role.
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