Deputy Program Integrity Director

5 days ago

Boston, United States EO of HHS PayRollGen Admin Full time

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 mínimal 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.
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