Job Information
Tufts Medicine Network Operations Manager TMIN in Burlington, Massachusetts
Our Integrated Network brings together a diversity of experienced private practice and employed physicians as well as community and academic providers. While we are one unified network, we focus on different geographic regions, with local care teams convening to ensure healthy, happy neighborhoods throughout the greater Boston region.
Remote with occasional onsite travel required.
Job Overview
Reporting to the Director of Network Operations, this position will collaborate with interdisciplinary Teams providing guidance and best practices on day-to-day issues and solutions. Leads or assists with various project work as needed such as contract implementation, operational and contracting resources for network and annual settlement. Serves as the primary liaison between TMIN and the payers acting upon the direction and needs of the Tufts Medicine Contracting Team. Meets regularly with stakeholders both internally and externally with the payers to manage both operations and performance driven meetings. Acquires and maintains an understanding of both network and payer deliverables, contract terms, performance metrics and other contractual terms as required.
This position provides a crucial interface between Tufts Medicine Integrated Network’s (TMIN), the TMIN Regions and LCOs, Tufts Medicine (TM) Contracting and the Payers. Provides structure, project management and resources to support TMIN initiatives with a focus on contracting operations. Manages and ensures compliance with the TMIN payer contracts and contractual deliverables through collaboration with applicable TMIN Departments, Regional/Local Leadership and the payers. Serves as a subject matter expert on details of TMIN’s payer contracts and programs.
Job Description
Minimum Qualifications:
Bachelor’s degree.
Seven (7) years of experience in health plans, managed care, practice management, physician liaison or health care data analysis.
Preferred Qualifications:
- Master’s degree.
Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.
Develops workflows and best practices within department.
Operations lead for the annual TMIN settlement process.
Assists in contract implementation for new and renegotiated payer contracts.
Serves as the subject matter expert to TMIN for payer contracts and programs.
Develops relationships with the various payer stakeholders.
Works in collaboration with Contract Manager to support the communication and issue resolutions with LCO leadership regarding contract terms.
Coordinates and leads assigned payer operations and performance meetings with coordination of necessary internal and external stakeholders to track and resolve issues related to the contract implementation, deliverables or ongoing management of the contract.
Assists with and/or coordinates general communications from Contracting to Regions/LCOs.
Acts as liaison to regional teams to field questions, understands local needs and requirements to support initiatives, etc.
Maintains tracking of payer deliverables and works with stakeholders on ensuring execution.
Supports Contracting by providing insight, recommendations, review and posting of internal documents for the network i.e. fee schedule distributions, contract summaries, product guides, etc.
Liaison to Contracting team to support operational needs during contract negotiations or renewals.
Collaborates with Regional Leadership on clinician and staff education on contracts.
Manages appropriate Teams sites that are dedicated to payer contracting operations or payer performance meetings.
Collaborates with Finance Department on team’s site postings as it relates to settlements or other contract deliverables.
Supports annual MHQP database validation as needed.
Participates in meetings as required.
Maintains collaborative team relationships with colleagues in order to effectively contribute to the working group’s achievement of goals and to help foster a positive work environment.
Physical Requirements:
Occasionally lift and/or move up to 25 lbs.
This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending/descending stairs and operating office equipment.
Frequently required to speak, hear, communicate and exchange information.
Ability to see and read computer displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.
Skills & Abilities:
Excellent organization, verbal, and written communication and planning skills.
Proven leadership skills with ability to create enjoyable trusting team environment.
Ability to work with senior leadership and colleagues at all levels of the organization.
Understanding of population health and risk-based contracting.
Ability to facilitate and manage an effective meeting.
Ability to effectively present information, respond, and follow-up on questions and inquiries staff of all levels.
Creative thinking and problem-solving skills, including conflict resolution.
Knowledge of health care delivery models and health care reimbursement.
Attention to detail, as well as an ability to think strategically.
Ability to develop collaborative relationships with commercial payer representatives.
Proficiency with Smartsheet, PowerPoint and Excel.
Ability to understand the importance of and respect for the confidentiality of all patient information in accordance with applicable standards and regulations.
Effective time management skills, logical problem solving and analytical skills with demonstrated attention to detail.
Proven ability to work well in a matrix environment.
Exemplifies exceptional customer focus.
Demonstrates leadership skills.
Good project and resource management skills.
Job Profile Summary
This role focuses on providing administrative and business support to the organization in order to achieve operational goals. In addition, this role focuses on performing the following Clinical Administration duties: Long-term strategic planning, determines strategic issues and opportunities that could affect practice success, prioritizes and tracks investments across practices, allocates resources and makes decisions regarding practice growth, and develops need to accomplish the practice's vision. A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs. The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education. A specialist level role that is a recognized subject matter expert in job area typically obtained through advanced education and work experience. Typically manages large projects or processes with limited oversight from manager, coaches, reviews and delegates work to lower level professionals, resolving difficult and often complex problems.
Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided 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. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org .