BFT - Program Director, Duals Implementation (Temporary)

Program Director, Duals Implementation (Temporary)

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.

Qualifications

Bachelor'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 / Competencies

• Deep understanding of clinical operations within a health plan, including care management, utilization management, and appeals & grievances
• Dual 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 context
• Skilled in designing and documenting workflows, policies, and procedures that support audit readiness and regulatory compliance
• Strong project execution skills, with the ability to track complex workstreams, manage interdependencies, and drive deliverables to completion
• Excellent written and verbal communication skills, with the ability to synthesize and translate complex requirements for a range of audiences
• Highly collaborative and solutions-oriented, with experience navigating matrixed teams and aligning stakeholders
• Demonstrated ability to operate effectively in dynamic, fast-paced environments with shifting priorities and evolving regulatory guidance

Physical Requirements

Remote Type

Hybrid

Work Location

399 Revolution Drive

Scheduled Weekly Hours

Employee Type

Temporary

Work Shift

Day (United States of America)

EEO Statement

The 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)-282-7642.

Mass General Brigham Competency Framework

At 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.