Healthcare Program Manager

1 month ago

Quincy, United States Talent Groups Full time

Position Title: Senior Program Manager

Location: 100 Hancock Street, Quincy, Massachusetts 02171

Duration : 1 +Year


Position Overview

Our client is seeking a highly skilled and experienced candidate to fill the Senior Program Manager (PM) position for the Standardized Encounter Data Program (SENDPRO). As the state agency responsible for administering the Commonwealth’s Medicaid program and its Children’s Health Insurance Program (collectively known as MassHealth), the client provides health coverage services to a diverse group of qualifying members, including families, individuals with disabilities, children, long-term unemployed adults, and seniors, through various programs such as fee-for-service and managed care.

MassHealth collaborates with Managed Care Entities (MCEs) that submit data detailing the services provided to MassHealth members, including payments made by the MCEs to the service providers—referred to as encounter data. This data is essential for numerous critical processes, including program integrity, rate development, CMS reporting, contract management, and health equity initiatives. The SENDPRO initiative aims to modernize the collection of encounter data by transitioning from a legacy file format to a standardized Electronic Data Interchange (EDI) X12 837 Post Adjudicated Claims Data Reporting (PACDR) and National Council for Prescription Drug Programs (NCPDP) Post Adjudication Standard format for Medical and Pharmacy Medicaid encounters. The 837 and NCPDP PACDR standards are tailored to support post-adjudicated claims and best align with MassHealth’s encounter data needs.

Reporting to MassHealth’s Director of Enterprise Data Management and Engineering (EDME), the Senior Program Manager will lead SENDPRO, overseeing internal development, testing, vendor management, and MCE communications. The role involves delivering the EDI solution, maintaining operational continuity during the transition from the legacy system, and ensuring SENDPRO meets its objectives for improving Encounter Data quality and enhancing MCE performance management. This position supports the agency’s commitment to enhancing data quality, completeness, and compliance. The role requires a blend of program and project management skills and offers high visibility within a significant technology initiative.


Job Duties and Responsibilities

  • Act as the Senior Program/Project Manager; coordinate tasks, workgroups, and deliverables among SENDPRO team members and stakeholders.
  • Define and execute program/project goals, priorities, and performance metrics to ensure alignment with agency priorities.
  • Oversee all phases of release management and implementation, including design, development, testing, and deployment.
  • Manage external vendors/system implementors to ensure service delivery standards are met.
  • Utilize program/project management best practices, methodologies, and tools to achieve objectives and drive efficiency.
  • Manage timelines for deliverables based on deadlines negotiated with stakeholders.
  • Lead program governance structures to inform and strategize decisions.
  • Prepare and present briefings to executives, including change requests for scope, timeline, and/or cost. Identify program risks, issues, and dependencies; develop and execute mitigation plans.
  • Monitor program performance, including vendor performance, contract management, milestone tracking, and financial cost management.
  • Lead a team of 25+ members, including business, technical, and vendor staff.
  • Foster a culture of collaboration, innovation, and continuous improvement within the SENDPRO team and among stakeholders.
  • Adapt to shifting priorities and timelines.
  • Engage with key stakeholders to understand their needs and ensure alignment with program/project objectives.
  • Manage stakeholder expectations, resolve conflicts, and facilitate consensus among diverse groups with competing priorities.
  • Ensure compliance with EOHHS’s program administration requirements.
  • Prepare status reports for the Executive Steering Committee and external reporting, including CMS.
  • Manage financial processes for MassHealth projects and provide updates for Leadership and the Annual IT Capital process.


Qualifications

Minimum Experience/Skills:

  • Bachelor's or Graduate degree in a relevant field (e.g., Computer Science, Engineering, Healthcare Management, Public Health, Business Administration, or Health Policy) or equivalent experience.
  • 5-7 years of experience in program and project management, preferably in healthcare or financial services.
  • 5-7 years of experience leading complex, technical, cross-organizational programs/projects, including data warehousing, data transformation, analytics, and systems integration.
  • Experience managing programs/projects with budgets over $1M.
  • Experience leading programs/projects involving 20+ staff, including vendor contractors.
  • Proven track record of delivering technical programs through the Software Development Lifecycle, from initiation to operationalization.
  • Experience utilizing project management principles and practices.
  • Strong problem-solving skills and the ability to resolve complex problems through structured processes.
  • Effective communication skills with both business and technical stakeholders.
  • Experience leading meetings and work sessions with all levels of staff and leadership.
  • Proficiency in Microsoft Office Suite (Word, PowerPoint, Excel, Project).


Preferred Experience/Skills:

Familiarity with agile principles and practices, with experience working in an agile environment and understanding of the Software Development Lifecycle.

Knowledge of Medicaid Encounter Data and T-MSIS (Transformed Medicaid Statistical Information System).

Ability to articulate project or program needs clearly.

Strong customer service orientation and understanding of customer needs.

Strong relationship-building capabilities with a focus on partnership.

Comfort with ambiguity and conflicting information.

Familiarity with projects involving cloud platforms.

Experience working in government healthcare agencies, public sector environments, health plans, or provider settings.

Knowledge of the Massachusetts healthcare landscape and key healthcare stakeholders.

Project Management Professional (PMP) Certification.

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