Director of Membership Retention

Written by jtranford - - Comments Off on Director of Membership Retention
Harbor Health
January 12, 2022
Mattapan, Massachusetts
Job Type


Director of Membership Retention


Mattapan, MA, US

2 days agoRequisition ID: 1748

The Director of Membership Retention for the Elder Service Plan is a key role reporting to the Senior Vice President, overseeing three departmental functions critical to the success of member retention.  These include management of the annual Medicaid process, member experience, and the clinical evaluation process.   

The Elder Service Plan is a PACE program (Program for All Inclusive Care for the Elderly) which offers a personalized healthcare program provided by our own geriatric professionals guided by a care plan developed and customized for our participants needs. 

Job Duties: 

  • Provides direct oversight of the Membership team, including those responsible for the Medicaid redetermination process, member service specialists, and Minimum Data Set (MDS) nurses.
  • Sets guidelines for submission of initial State assessment and monitors adherence to support the Enrollment team in meeting their goals.
  • Identifies trends and opportunities to improve departmental functions and identifies emerging obstacles to achieving departmental goals.
  • Responsible for evaluating and developing processes that ensures team meets state required deadlines to retain participant enrollment.
  • Manages external relationships, specific to the facilitation and improvement of Membership department related efforts – law firms, Vendors, SNF Business Managers, etc.
  • Maintains a productive working relationship with various State agencies to ensure expedient and accurate processing of related work.
  • Ensures the implementation of all policies and procedures related to the Membership department’s objectives and develops new ones as necessary.
  • Works closely with the Director of Marketing & Enrollment and IDTs to ensure an efficient transition into PACE for new enrollees.
  • Works closely with the Director of Quality & Compliance and Utilization Management department to develop and maintain an efficient disenrollment process for enrollees.
  • Creates and implements processes for evaluating and preventing voluntary disenrollments.
  • Ensures the timely and accurate completion of required disenrollment procedures monthly utilizing multiple systems (Medicaid - MMIS system & MEC Letters, Pharmastar – report submission, Finance – MH disenrollment report review).
  • Maintains knowledge of Medicaid operational and regulatory changes.  Advises Finance team as well as ESP leadership in a timely manner.
  • Serves as an internal and external primary point of contact for all participant related billing issues.
  • Develops and maintains a customer service function to serve as a go-to for Medicaid, Medicare, LTC and billing related issues
  • Develops and maintains an efficient participant experience strategy within ESP focusing on participant satisfaction, onboarding/orientation, and participant retention.
  • Implements standards and systems to improve workflows and operational efficiencies, ensuring that those workflows are transferable to multiple sites.
  • Works closely with internal and external entities to prevent and recoup loss of revenue.
  • Maintains a thorough understanding of Medicaid and NPA participant enrollment requirements.
  • Creates and oversees a method of tracking and evaluating the Medicaid renewal application process.
  • Creates and oversees a method of tracking and evaluating the Long-Term Care conversion process.
  • Responsible for recruitment, development, retention, discipline (as needed) and evaluation of all Membership Retention staff.

Preferred/Required Education, Experience and Skills: 

  • Bachelor’s degree in related field required (Marketing, Business Administrations, Healthcare Administration), Masters preferred
  • 3 years of process improvement, management, recruitment, enrollment, insurance, marketing or business development experience.
  • Intermediate knowledge of Microsoft Word and Excel.
  • Proven problem-solving skills and critical thinking skills.
  • Excellent verbal and written communication skills.
  • Excellent customer service skills.
  • Demonstrated account management or sales success.
  • Operations experience preferred.
  • CRM software experience preferred.
  • Proven interest and ability to learn new software programs

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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