Senior Director of Provider Network

Title: Senior Director of Provider Network

Reports to:  Executive Director of SCO and One Care

Classification: Senior Director Level

Location: Boston

Job description revision number and date:  V, 2.0 10/21/2024

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Quality Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.

We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners. We have won “Best Places to Work” recognition from the Boston Globe for the last three consecutive years.

SCO and One Care Summary:

The Senior Care Options (SCO) and One Care programs are health plan programs for dually eligible (Medicare and Medicaid) individuals (“duals”) in Massachusetts. SCO serves eligible beneficiaries aged 65 , while One Care serves duals between ages 21-64. These programs are fully integrated dual-eligible special needs plans (FIDE-SNP) that integrate Medicare and Medicaid benefits, along with additional support for enrollees such as integrated care teams, care managers, social supports, etc.

Massachusetts’ Medicaid agency recently conducted a procurement for health plans to offer products in these two programs, for a five year term starting January 1, 2026. C3 submitted a bid and was selected in September 2024.

Job Summary:

The Senior Director of Provider Network will be a critical member of the new Senior Care Options and One Care and leadership teams. The Senior Director will be responsible for the overall strategy and operation of the organization’s provider network, including the initiation, negotiation, and management of contracts with providers and health systems.

This role will report directly to the Executive Director of SCO and One Care and work closely with members of the C3 Leadership Team. The Senior Director in this role will have the opportunity to play a critical role in a mission-driven health plan in its early stages and provide critical input on the implementation and design of products focused around enrollees and supportive of keeping individuals in the community through the execution of independent living philosophy. 

Responsibilities:

• Responsible Lead on ensuring our SCO and One Care Plans have a comprehensive provider network that meets regulatory requirements and the needs of our Enrollees
• Lead and manage the organization’s strategy related to adequacy, access, quality of services, and expansion of contracted network providers
• Manage and support the Contract Manager(s) in the procurement of provider network contracts
• Collaborate with the SCO and One Care Executive Director on contract compliance and optimization related to provider network contracting
• Oversee the organization’s provider relations function, including management of the Provider Relations Manager, provider data collection and management, and provider onboarding and training
• Work with the Medical Director and other key partners to ensure the provider network meets the organization’s Model of Care and is able to provide exceptional care to enrolled members
• Initiate, negotiate, and execute provider network contracts for SCO and One Care
• Work with our Payer Solutions team to ensure the execution of back-end systems related to onboarding new providers
• Oversee the implementation of Single Case Agreements in coordination with the Medical Management team to ensure comprehensive access to care for Enrollees in need of out-of-network services

Required Skills:

• Understanding of provider network contracting on behalf of health plans
• Excellent verbal and written communication skills
• Proficient in Microsoft Office Suite or related software
• Excellent ability to conceptualize long-term business goals and develop orderly processes to accomplish those goals
• Excellent managerial skills
• High attention to detail

Other Desired Skills:

• Experience with anti-racism activities, and/or lived experience with racism is highly preferred
• Experience with a dual eligible special needs plan is preferred

Qualifications:

• Bachelor’s degree; ideal candidate has a Master’s or other advanced degree in Public Health, Public Administration, Business Administration, or another concentration relevant to this role
• At least 5 years of health care experience, inclusive of Medicaid, Medicare, and/ or health plan administration. The ideal candidate has direct experience working at government and/ or at a health plan on one or more programs that serve dually-eligible beneficiaries
• At least 3 years of experience in provider contracting on behalf of a health plan, including experience with Medicare and Medicaid regulations related to contracting and provider networks
• At least 3 years of managerial and/or leadership experience

** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **