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.

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 :

Skills / Abilities / Competencies :

Supervisory Responsibilities :

Physical Requirements

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.