Manager, DSNP Member Enrollment & Redetermination

The Manager, Member Enrollment and Redetermination for Senior Care Options and One Care, will partner cross-functionally on the enrollment and redetermination implementation and testing activities. The Manager will be responsible for managing the day-to-day, monthly, and annual activities of the products to meet CMS and EOHSS regulatory requirements. This includes responsibility for monitoring accuracy and timeliness, forecasting, planning, reconciliation, training and evaluating. The successful candidate will be an active participant on cross-functional teams to address strategic business initiatives and be a resource for both internal and external business partners.

Principal Duties and Responsibilities:

• Attend and be an active participate in Senior Care Options and One Care implementation and testing activities.
• Provide direction to Senior Care Options and One Care Enrollment and Redetermination Staff to meet CMS and EOHSS regulatory requirements.
• Manage and train staff to address concerns from both internal and external stakeholders.
• Engage, empower, and encourage staff; lead through change and adversity. Make decisions as needed and build consensus as appropriate.
• Identify and create the processes and align resources to accomplish key objectives; clearly convey and assign accountability for important objectives, deadlines, and expectations.
• Hire, participate in and/or recommend development measures and disciplinary actions up to and including termination, evaluate performance, and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance and hold regular development conversations.
• Responsible for overseeing day-to-day Enrollment and Redetermination activities including file loads, processing transactions, paper and online enrollments, urgent requests, and reconciliation.
• Ensure accuracy of all transactions through research, follow-up, and resolution of issues.
• Collaborate with internal business areas and external business partners to resolve issues and escalate as appropriate.
• Responsible for all DSNP Enrollment and Redetermination related member communication material
• Develop and refresh P&Ps and Job Aids
• Ensure that quality assurance issues are addressed in a timely manner.
• Key eligibility contact for vendor partners such as Dental, ID Card and Pharmacy.
• Work with IT to approve and prioritize tickets entered by team members.
• Build strong relationships and deliver solutions that meet expectations; establish and maintain effective relationships both internally and externally.
• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve-our members, providers, brokers, and employers-front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• 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:

• Bachelor's degree required or the equivalent combination of training and experience, plus 5+ years of related experience.
• 5+ years of Medicare Advantage and/or DSNP enrollment experience preferred.
• 3+ years of Medicare Advantage and/or DSNP enrollment leadership experience preferred.

Skills/Abilities/Competencies:

• Microsoft Office (Word, Excel, PowerPoint, Visio)
• EAM and QNXT experience a plus
• Excellent leadership skills and leadership track record.
• Problem solving, leadership and independent initiative.
• 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.
• 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.

Supervisory Responsibilities:

• Motivate and encourage staff of 5+; lead through change and adversity. Make decisions as needed and build consensus as appropriate. Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Set clear goals and objectives and use metrics to measure performance and hold staff accountable. Provide coaching to improve performance and hold regular development discussions with direct reports. Recognize staff for their contributions.

• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve-our members, providers, brokers, and employers-front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.

Physical Requirements

• Standing Occasionally (3-33%)
• Walking Occasionally (3-33%)
• Sitting Constantly (67-100%)
• Lifting Occasionally (3-33%)
• Carrying Occasionally (3-33%)
• Pushing 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%)