Commonwealth Care Alliance
Program Manager, LTSS Contract Operations
Commonwealth Care Alliance, Boston, Massachusetts, us, 02298
Program Manager, LTSS Contract Operations
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.
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 hybrid role with the expectation of working during 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 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 ASAPs and 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
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 to a wide range of audiences
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 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
Referrals increase your chances of interviewing at Commonwealth Care Alliance.
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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 hybrid role with the expectation of working during 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 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 ASAPs and 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
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 to a wide range of audiences
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 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
Referrals increase your chances of interviewing at Commonwealth Care Alliance.
#J-18808-Ljbffr