Medicare Advantage Policy Manager

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Manager of Policy and Knowledge Management in the Medicare Advantage Customer Service department is responsible for business analysis, leadership and management of our knowledge management program, and Policy and Procedure (P&P) creations. The Manager will be responsible for overseeing the development and implementation of knowledge management systems and policies within our organization. The Manager will possess a strong background in research, analysis, and policy development, along with excellent organizational and leadership skills. All aspects of the policy and knowledge management implementation will need to encompass strict adherence to CMS regulations and internal compliance controls specific to the Medicare Advantage line of business.

As the Knowledge and Policy Manager, you will lead a team of professionals in collecting, organizing, and disseminating information to support decision-making processes. You will collaborate with leaders of all Medicare Advantage departments to identify knowledge gaps and develop strategies to address them. Additionally, responsible for developing and maintaining policies needed to successfully pass internal or external audits, and create a five star plan. Will serve as a back-up for the Customer Service Manager as needed.

The Manager will have inherent leadership qualities to facilitate constructive discussions/planning sessions including real-time synthesis, asking objective/challenging questions to create clarity when it does not exist (process or content).

Responsibilities:

The Manager will report to the Director of Customer Service, and will work closely with stakeholders and peers in Enrollment & Billing, Information Technology, Provider Network Management, Claims, Marketing, Legal, Regulatory, Compliance, and other functional areas.

Developing department documents to support new Medicare plan types MGBHP may contract with CMS to offer.

Create, align, and manage the internal and external Knowledge roadmap.

Work closely with IT leadership to implement a new system/tool and vendor management related to the chosen system. Maintain of the tool as business/regulatory needs change.

Maintain current list of subject matter experts, by topic, for distribution of memos and documented P&Ps related to the Customer Service vendors and oversight of these vendors.

Responsible for leading the annual review/revision of Medicare Programs' policies and procedures.

Creates and maintains applicable policies and procedures for the Medicare Advantage Customer service Department, with a strong knowledge of regulatory rules and regulations being at the center of all policies.

Simplify complexity of the P&Ps for the Customer Service team to translate the information simply for our members.

Design, develop, and implement automated workflows, including integrating existing tools and systems to improve efficiency and effectiveness.

Sends out monthly reminders in advance of deadlines, answering business area questions as they arise and ensuring updated documents are posted to our Knowledge Management system timely.

Define and drive mechanisms that help ensure our internal and external customers can find the knowledge and resources they need quickly and easily.

Partner with Marketing to ensure all knowledge and policies are consistent with the Website and Member Portal.

Will work closely with the Director of Customer Service and Medicare compliance leadership to participate in CMS calls or audits, to speak to our policies and procedures

Analyze data and make informed decisions to optimize knowledge management and policy creation.

Mentor, coach, and provide support to customer service staff with respect to how they implement our P&Ps and job aids in their day-to-day work.

Will coordinate with Learning and Development to create content for new-hire and on-going training within the Medicare Advantage Customer Service department

Hold self and others accountable to meet commitments.

Ensure diversity, equity, and inclusion are integrated as a guiding principle.

Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.

Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

Other duties as assigned with or without accommodation.

Qualifications:

Required:

• Bachelor's degree in a relevant field such as healthcare administration, public policy, or related discipline required.
• Minimum of 10 years of experience working with Medicare policies and guidelines, with strong knowledge of regulations, specifically with respect to CMS oversight.
• Leadership experience, working with leaders on process improvement and drive to develop proper P&Ps and knowledge dissemination.
• Ability to people lead as the business needs develop.
• Strong knowledge of Medicare regulations and policies, including experience interpreting and applying complex CMS memos, regulation changes, and guidelines
• Exceptional analytical and problem-solving skills, with the ability to identify and resolve policy-related issues
• Excellent written and verbal communication skills, with the ability to effectively communicate complex ideas to diverse stakeholders
• Strong attention to detail and ability to manage multiple projects and priorities simultaneously
• Demonstrated ability to work well in cross-functional teams and collaborate effectively with colleagues at all levels of the organization

Skills/Abilities:

Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.

Bring fresh ideas forward by listening to and working with employees and the people we serve.

Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.

Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.

Strong aptitude for technology-based solutions.

Ability to inject energy, when and where it's needed.

Current in healthcare trends.

Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."

Ability to develop, introduce, defend, and gain support for a new ideas and approaches.

Excellent leadership skills and leadership track record.

Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.

Ability to view the long-range trends and cycles of the business and industry and see the "big picture."

Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.

Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.

Excellent interpersonal skills, including the ability to influence others at all levels of an organization.

Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.

Unquestionable integrity.

The Mass General Brigham Health Plan is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.