Site: Mass General Brigham Health Plan Holding Company, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Director, Behavioral Health Operations, is responsible for leading operational oversight and execution support for Mass General Brigham Health Plan's Behavioral Health vendor relationship and related business processes. This role serves as a key operational liaison among internal business owners, Clinical Behavioral Health, Product, IT, Customer Service, Provider Relations, Claims, Compliance, and external Behavioral Health vendors to ensure vendor operations are aligned with regulatory, contractual, benefit, claims, provider, and member experience requirements.
The role is accountable for supporting accurate and timely implementation of Behavioral Health operational requirements in vendor and internal systems, monitoring operational performance and issue resolution, coordinating cross-functional remediation of member, provider, and broker friction points, and ensuring business stakeholders have clear visibility into vendor-related operational risks, trends, and action plans.
Essential Functions
-Lead operational oversight of Behavioral Health vendor administration, including coordination of business processes, issue resolution, implementation support, and ongoing monitoring of key operational deliverables.
-Serve as a primary operational liaison between MGB Health Plan and designated Behavioral Health vendors, currently Optum Behavioral Health, and any other Behavioral Health service vendors designated by the Chief Operating Officer.
-Partner with Clinical Behavioral Health, Product, IT, Claims, Customer Service, Provider Relations, Compliance, and line-of-business leaders to ensure vendor operations support Medicaid, Medicare Advantage, Commercial, and other applicable business requirements.
-Monitor operational compliance with federal and state regulatory requirements, contractual obligations, benefit coverage requirements, provider payment expectations, member cost-sharing rules, and related operational standards.
-Support Mental Health Parity compliance activities, including participation in the Mental Health Parity Committee, coordination of operational inputs, issue follow-up, and alignment of Behavioral Health vendor operations with parity-related requirements and action plans.
-Coordinate with IT application business owners (e.g., QNXT, Epic, etc.) and other system stakeholders to support appropriate application of business rules across internal and vendor systems.
-Support escalated member, provider, broker, and customer service issues by providing operational analysis, expected claims or benefit outcome guidance, and coordination of appropriate remediation steps.
-Identify, track, and escalate operational risks, defects, trends, and recurring issues related to Behavioral Health vendor operations, claims processing, benefit implementation, provider payment, member experience, and operational handoffs.
-Review operational outputs from delegated vendors, conduct ad hoc analysis to validate performance, identify trends or deficiencies, and oversee development, execution, and follow-through of corrective action plans, including review of claims processing adjustments to confirm accuracy, root cause, member or provider impact, and completion of remediation steps.
-Develop and maintain documentation of key Behavioral Health operational processes, decision points, issue logs, action plans, vendor commitments, and business requirements.
-Coordinate cross-functional workgroups as needed to address member, provider, broker, employer, or internal stakeholder friction points related to Behavioral Health operations.
-Support continuous improvement by identifying process gaps, recommending workflow improvements, and helping implement operational controls that improve quality, consistency, accountability, and transparency.
-Prepare and present concise updates, issue summaries, recommendations, and decision materials for executive and operational leadership.
Education
- Bachelor's Degree Related Field of Study required or Master's Degree Related Field of Study preferred
Experience
- 8-10+ years of healthcare administration, business administration, public health, health insurance experience required
- At least 5-7 years of experience leading cross-functional operational work, vendor oversight, program execution, or complex healthcare operations preferred
- At least 5-7 years of experience working with Behavioral Health operations, managed care vendors, claims processing, benefit implementation, regulatory requirements, and member or provider issue resolution preferred
Knowledge, Skills, and Abilities
- Proven track record of effective change management, including but not limited to agile, waterfall, and hybrid project management, navigating organizational norms and business processes across institutions.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states with a strong preference for local candidates who could attend occassional in-person meeting
- This is a Monday-Friday role with standard business hours (in Eastern time)
Hybrid
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$124,342.40 - $180,897.60/Annual
Grade
9
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
