Mass General Brigham · 2 hours ago
Behavioral Health Program Manager
Somerville, MA
Full-time
Hybrid
Senior Level
$80K/yr - $116K/yr
5+ years expMass General Brigham is a not-for-profit organization that supports patient care, research, teaching, and community service. The Behavioral Health Program Manager is responsible for developing and implementing policies and procedures to ensure compliance with Medicare and Medicaid regulations, while collaborating with various departments to support Behavioral Health clinical initiatives and performance evaluations.
HealthcareHealth CareHome Health CareMedical
Responsibilities
Ensures BH clinical and operational compliance with all state and federal Medicare and/or Medicaid regulations including but not limited to CMS Annual Final Rule requirements, Advancing Interoperability & Prior Authorization, letter and reporting templates, etc
Responsible for oversight and auditing of all BH Medicare reporting (e.g., ODAG, Part-C, HSD reporting, First Tier, Downstream, and Related Entities (FDRs) monitoring, etc.) – including reporting results out to key stakeholders and assisting with identifying and implementing corrective action plans when deficiencies are noted
Acts as the point of contact for all BH member and provider issues including escalations – this includes both clinical and operational escalations
In collaboration with the Compliance department, develops Corrective Action Plans when issues with non-compliance are identified and work collaboratively to resolve all deficiencies within the timeline established
Conducts analysis and evaluation through monitoring data (i.e., outcomes, cost, and utilization)
Supports clinical initiatives as needed. Completes data analysis when appropriate
Performs program evaluation as indicated
Makes recommendations to the Steering Committee based on oversight activities
Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains positive relationships with customers and gains their trust and respect
Holds self and others accountable to meet commitments
Persists in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise
Builds positive relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization
Performs other duties as assigned
Complie with all policies and standards
Qualification
Required
Master's degree required
At least 5-7 years of directly related Medicare and/or Medicaid health insurance experience required
At least 3-5 years of compliance experience – operating within a compliance framework to read, understand, operationalize and oversee adherence to regulatory requirements required
At least 2-3 years of managed care, managed behavioral healthcare or service delivery experience, including data analysis and reporting processes required
Strong verbal, active listening, and written communication skills required
Preferred
LICSW, LMHC, or LMFT preferred
At least 2-3 years of CMS/Medicare auditing experience preferred
At least 2-3 years of mental health parity experience preferred
Benefits
Comprehensive benefits
Career advancement opportunities
Differentials
Premiums and bonuses as applicable
Recognition programs designed to celebrate your contributions and support your professional growth
Company
Mass General Brigham
Mass General Brigham specializes in providing medical treatments and health diagnostics services.
10001+ employees
H1B Sponsorship
Mass General Brigham has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (77)
2024 (61)
2023 (93)
2022 (70)
2021 (80)
2020 (29)
Funding
Current Stage
Late StageLeadership Team
E
Erin Flanigan
SVP, Talent
O’Neil A. Britton
Chief Integration Officer, Executive Vice President
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