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. The Program Director, Duals Implementation (Temporary) will support the Clinical department in achieving operational readiness for the launch of Mass General Brigham Health Plan's Dual-Eligible Special Needs Plan (D-SNP), including One Care and Senior Care Options (SCO). This role will provide targeted, hands-on support across Coordinated Care, Utilization Management, and Appeals & Grievances, documenting compliant workflows, managing cross-functional dependencies, and supporting readiness validation in alignment with CMS, MassHealth, and Model of Care requirements. This temporary position is expected to start in July and go through November 2025, with the possibility of extension based on organizational needs and performance.
QualificationsBachelor's degree required, advanced degree in Public Health, Health Administration, Nursing, or related field preferred. Five to seven years of experience in health plan operations, including D-SNP (One Care and SCO). Experience with D-SNP Model of Care implementation preferred. Knowledge of CMS and state level requirements related to clinical operations. Strong organizational and project management experience required, preferably in a healthcare setting. Proficiency in Microsoft Office Suite.
Skills/Abilities/CompetenciesDeep understanding of clinical operations within a health plan, including care management, utilization management, and appeals & grievancesDual eligible subject matter expertise or corresponding expertise in Medicare or Medicaid clinical requirements and operations.Strong ability to interpret and apply CMS, MassHealth, and Model of Care requirements in a practical, operational contextSkilled in designing and documenting workflows, policies, and procedures that support audit readiness and regulatory complianceStrong project execution skills, with the ability to track complex workstreams, manage interdependencies, and drive deliverables to completionExcellent written and verbal communication skills, with the ability to synthesize and translate complex requirements for a range of audiencesHighly collaborative and solutions-oriented, with experience navigating matrixed teams and aligning stakeholdersDemonstrated ability to operate effectively in dynamic, fast-paced environments with shifting priorities and evolving regulatory guidancePhysical RequirementsStanding Occasionally (3-33%)Walking Occasionally (3-33%)Sitting Constantly (67-100%)Lifting Occasionally (3-33%) 20lbs - 35lbsCarrying Occasionally (3-33%) 20lbs - 35lbsPushing Rarely (Less than 2%)Pulling Rarely (Less than 2%)Climbing Rarely (Less than 2%)Balancing Occasionally (3-33%)Stooping Occasionally (3-33%)Kneeling Rarely (Less than 2%)Crouching Rarely (Less than 2%)Crawling Rarely (Less than 2%)Reaching Occasionally (3-33%)Gross Manipulation (Handling) Constantly (67-100%)Fine Manipulation (Fingering) Frequently (34-66%)Feeling Constantly (67-100%)Foot Use Rarely (Less than 2%)Vision - Far Constantly (67-100%)Vision - Near Constantly (67-100%)Talking Constantly (67-100%)Hearing Constantly (67-100%)Remote TypeHybrid
Work Location399 Revolution Drive
Scheduled Weekly Hours0
Employee TypeTemporary
Work ShiftDay (United States of America)
EEO StatementThe General Hospital Corporation is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-.
Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
Read LessMass 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. The Program Director, Duals Implementation (Temporary) will support the Clinical department in achieving operational readiness for the launch of Mass General Brigham Health Plan's Dual-Eligible Special Needs Plan (D-SNP), including One Care and Senior Care Options (SCO). This role will provide targeted, hands-on support across Coordinated Care, Utilization Management, and Appeals & Grievances, documenting compliant workflows, managing cross-functional dependencies, and supporting readiness validation in alignment with CMS, MassHealth, and Model of Care requirements. This temporary position is expected to start in July and go through November 2025, with the possibility of extension based on organizational needs and performance.
QualificationsBachelor's degree required, advanced degree in Public Health, Health Administration, Nursing, or related field preferred. Five to seven years of experience in health plan operations, including D-SNP (One Care and SCO). Experience with D-SNP Model of Care implementation preferred. Knowledge of CMS and state level requirements related to clinical operations. Strong organizational and project management experience required, preferably in a healthcare setting. Proficiency in Microsoft Office Suite.
Skills/Abilities/CompetenciesDeep understanding of clinical operations within a health plan, including care management, utilization management, and appeals & grievancesDual eligible subject matter expertise or corresponding expertise in Medicare or Medicaid clinical requirements and operations.Strong ability to interpret and apply CMS, MassHealth, and Model of Care requirements in a practical, operational contextSkilled in designing and documenting workflows, policies, and procedures that support audit readiness and regulatory complianceStrong project execution skills, with the ability to track complex workstreams, manage interdependencies, and drive deliverables to completionExcellent written and verbal communication skills, with the ability to synthesize and translate complex requirements for a range of audiencesHighly collaborative and solutions-oriented, with experience navigating matrixed teams and aligning stakeholdersDemonstrated ability to operate effectively in dynamic, fast-paced environments with shifting priorities and evolving regulatory guidancePhysical RequirementsStanding Occasionally (3-33%)Walking Occasionally (3-33%)Sitting Constantly (67-100%)Lifting Occasionally (3-33%) 20lbs - 35lbsCarrying Occasionally (3-33%) 20lbs - 35lbsPushing Rarely (Less than 2%)Pulling Rarely (Less than 2%)Climbing Rarely (Less than 2%)Balancing Occasionally (3-33%)Stooping Occasionally (3-33%)Kneeling Rarely (Less than 2%)Crouching Rarely (Less than 2%)Crawling Rarely (Less than 2%)Reaching Occasionally (3-33%)Gross Manipulation (Handling) Constantly (67-100%)Fine Manipulation (Fingering) Frequently (34-66%)Feeling Constantly (67-100%)Foot Use Rarely (Less than 2%)Vision - Far Constantly (67-100%)Vision - Near Constantly (67-100%)Talking Constantly (67-100%)Hearing Constantly (67-100%)Remote TypeHybrid
Work Location399 Revolution Drive
Scheduled Weekly Hours0
Employee TypeTemporary
Work ShiftDay (United States of America)
EEO StatementThe General Hospital Corporation is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-.
Mass General Brigham Competency FrameworkAt Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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