Program Manager, LTSS Contract Operations

011150 CCA-Network Contracting

Position Summary:

The LTSS Program Manager is responsible for overseeing relationships and performance with community-based Long-Term Services and Supports (LTSS) provider organizations that serve One Care and Senior Care Options (SCO) members across Massachusetts. This role manages the performance of Commonwealth Care Alliance's (CCA) contracted community-based organizations (CBOs), including Aging Services Access Points (ASAPs) and Long-Term Services Coordinators (LTSC) agencies, ensuring alignment with CCA's model of care and strategic objectives.

The Manager fosters effective clinical and programmatic collaboration with provider partners, communicates performance expectations and outcomes, and leads performance evaluation and improvement efforts. Through reporting, data analysis, and partnership management, the LTSS Program Manager ensures that providers meet contractual, regulatory, and quality standards that optimize member outcomes and operational efficiency.

This role is accountable for ensuring that external provider relationships are high-performing, well-coordinated, and fully integrated with CCA operations so that members' LTSS needs are met in a manner that supports quality, independence, and cost-effective community-based care. The Manager also ensures providers are educated on CCA policies, processes, and structures to enhance collaboration and service quality.

This position offers broad exposure across multiple organizational areas and requires close collaboration with internal leadership, operations teams, and external provider partners. The ideal candidate demonstrates strong organizational, analytical, and relationship-management skills, with the ability to engage diverse stakeholders to identify opportunities and drive both program-wide and provider-specific performance improvement.

The LTSS Program Manager reports to the Senior Director of Delegation Partnerships and Provider Engagement. The Provider Engagement team is responsible for building and maintaining relationships with key provider partners to advance CCA's network partnership, quality, and performance objectives.

Supervision Exercised:

No, this position does not have direct reports.

Essential Duties & Responsibilities:

Provider Engagement and Relationship Management

• Serve as the primary liaison for assigned community-based LTSS provider organizations, with a focus on ASAPs, LTSCs, and GSSCs.
• Build and maintain strong, collaborative relationships with provider partners to promote transparency, accountability, and mutual success.
• Conduct regular provider meetings (virtual and in-person) to review performance, discuss program updates, and address operational challenges.
• Represent CCA's LTSS model of care and ensure provider alignment with contractual, operational, and quality expectations.
• Partner with internal teams to address provider issues and ensure timely resolution.

Performance Management

• Oversee onboarding, training, and ongoing engagement of CCA's LTSS network, including ASAP and LTSC agencies.
• Lead the monitoring and analysis of provider performance using utilization, quality, and member experience metrics.
• Collaborate with Business Intelligence, Finance, Quality, and Contracting to develop and disseminate performance reports and dashboards.
• Develop, implement, and track provider performance improvement plans in partnership with internal and external stakeholders.
• Ensure compliance with all regulatory and contractual requirements related to LTSS provider reporting and quality standards.
• Maintain ownership of provider guidance materials, ensuring accuracy and consistency across policies, procedures, and training tools.
• Support pay-for-performance and value-based contracting programs through data analysis and performance oversight.

Program Operations and Development

• Support the design, implementation, and continuous improvement of LTSS program operations, policies, and workflows related to ASAPs and LTSCs.
• Collaborate with cross-functional teams to ensure operational alignment and data accuracy, including roster reconciliation, payment processes, and reporting.
• Manage special projects related to program development, process redesign, and strategic growth.
• Maintain an organized reporting inventory and ensure consistent and timely dissemination of performance data to providers.
• Support the development and communication of SOPs, reference guides, and workflows to enhance operational efficiency across LTSS partners.
• Coordinate updates and maintain LTSS provider materials on CCA's Extranet/SharePoint to ensure accurate and accessible resources.

Cross-Functional Collaboration and Continuous Improvement

• Work collaboratively with internal departments—including Clinical Operations, Contracting, Network Management, Utilization Management, and Business Intelligence—to align LTSS performance priorities and initiatives.
• Support Provider Engagement leadership in advancing enterprise-wide initiatives related to provider partnerships, care coordination, and program integration.
• Contribute to quality improvement projects, audits, and performance reviews to strengthen LTSS provider engagement and member outcomes.
• Identify and share best practices to enhance provider collaboration and the overall member experience.

Working Conditions:

• This is a remote or hyrbrid role with the expectation of working according to Commonwealth Care Alliance's standard operating hours of 8:30am-5pm Monday-Friday. Ability to travel to provider offices and access to reliable transportation.

Required Education (must have):

• Bachelor's degree

Desired Education (nice to have):

• Bachelor's degree in public health, health management, social work, or a related field preferred.

Required Licensing (must have):

Desired Licensing (nice to have):

MA Health Enrollment (required if licensed in Massachusetts):

• No, this is not required for the job.

Required Experience (must have):

• 5+ years
• Experience with Medicaid and Medicare products and programs
• Experience or knowledge of community based services for seniors and disabled individuals, including knowledge of Disability Networks

Desired Experience (nice to have):

• Experience with dual-eligible (SCO or One Care) populations preferred.
• Experience in healthcare program management, provider relations, or network management
• Knowledge of Massachusetts LTSS landscape, including ASAPs, GSSCs, LTSCs, and ILCs

Required Knowledge, Skills & Abilities (must have):

• Proven experience in program management and performance monitoring initiatives or relevant position within healthcare or community-based service settings
• Demonstrated ability to analyze performance, utilization, and quality data, interpret insights, and translate findings into actionable strategies.
• Proficiency in Microsoft Office Suite (especially Excel and PowerPoint); comfort with data dashboards, reporting tools, and learning new systems and databases.
• Excellent project management and organizational skills, with the ability to manage multiple priorities, meet deadlines, and coordinate across diverse internal and external stakeholders.
• Exceptional written and verbal communication skills, with the ability to present complex information clearly and effectively to a wide range of audiences, including senior leadership and external partners.
• Strong relationship management and collaboration skills, with the ability to build trust, influence others, and work effectively in a matrixed environment.
• Professional presence, sound judgment, and diplomacy in managing sensitive or high-stakes provider relationships.
• Excellent organizational, time-management and problem-solving skills
• Proactive in identifying issues and developing effective solutions.
• Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines.
• Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals.
• Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically.
• Must be able to work collaboratively and create an atmosphere of trust and respect within project teams and with external partners
• Strong tactical performer
• Must be able to exercise a high level of diplomacy to recognize politically sensitive issues
• Ability to multi-task and switch gears quickly / effectively

Required Language (must have):

• English

Desired Knowledge, Skills, Abilities & Language (nice to have):

• Familiarity with care management and utilization management systems and workflows for populations with complex medical, behavioral health, and/or social needs.
• Strong understanding of Medicare, Medicaid (MassHealth), and dual-eligible program operations , including regulatory and compliance requirements.
• Demonstrated ability to describe and assess a simple business problem
• Demonstrated ability to define a solution to a simple business problem and develop a plan for resolution
• Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies;