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Fallon Health Vice President, Medicaid Programs - Growing in Government-sponsored Health Insurance! in Worcester, Massachusetts


About Fallon Health

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon delivers equitable, high-quality coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region.


The Vice President, Medicaid Programs, is the senior executive responsible for the MassHealth ACO program and other Medicaid-related programs as needed. In coordination with the Chief State Programs Officer, this senior leader formulates program(s) strategy and oversees it successful execution. The role has profit and loss responsibility for the program(s). Other key aspects of the role include financial analysis and support; relationship management with ACO partners, governmental, other external stakeholders as well as internal departments; and compliance and operational oversight.

The candidate needs to be comfortable interacting with executive leadership of external entities and continually gauging satisfaction with Fallon Health. The Vice President must effectively position Fallon Health to maintain strong partnerships with ACOs and attract new provider partners. The Vice President is also responsible for working with each assigned ACO partner to develop financial and performance targets; develop and implement performance improvement initiatives; continually monitor performance; and regularly report results to partners and Fallon Health executive leadership. The position further supports the evaluation and initial implementation of new under age 65 Medicaid-based programs, such as the One Care program.



  • Develop and oversee multi-year strategic business plan for the program(s)

  • Report periodically to Senior Leadership on overall program(s) performance

  • Collaborate with ACO Partner leadership on strategic performance

  • Identify, assess, and recommend opportunities to grow the program(s)

  • Evaluate and oversee initial implementation of new under age 65 Medicaid-based program opportunities, including through the development of business plans, RFP responses and operational readiness efforts

Financial Performance

  • Hold profit and loss responsibility for program performance; this includes working closely with Fallon’s Finance and Care Services teams to advance program profitability and sustainability, including:

  • ACO Partner Rate and Risk Sharing Development

  • Revenue Management

  • Medical Expense Management

  • General & Administrative Expenses

  • Set and meet membership targets for the program(s)

  • Collaborate with the Actuarial, Medical Economics and Risk Adjustment departments to advance ACO financial performance as well as actionable analysis and reporting

  • Develop and present regular performance reports to ACO Partners

Relationship Management

  • Develop and maintain excellent relationships with ACO partner leadership and staff and key providers

  • Build and manage effective relationships with MassHealth, related state agencies, and other external stakeholders, as needed, including through effective advocacy of organizational and program concerns

  • Work closely with key internal departments to ensure the effective implementation and operation of program requirements and initiatives, including Finance, Actuarial, Network Development & Management, Care Services, Compliance, Operations, and Communications


  • Oversee program compliance with both federal and state agencies

  • Develop expertise in MassHealth contractual requirements and financial models and serve as a resource for provider partners and internal areas

  • Work closely with the Senior Director of ACO Product Management and State Programs team to resolve any operational issues raised by the ACO Partners


  • Demonstrate a commitment to the Fallon Health’s Vision, Mission, and Values, leading with empathy, partnership, inclusivity, commitment and creativity.

  • Possess strong competencies as follows:

  • Effective leadership ability

  • Creative problem solver

  • Adaptability

  • Builds relationships

  • Excellent verbal and written communication skills, including presentation skills

  • Excellent interpersonal skills


  • MBA, MHS, MPH, MS or equivalent degree required

  • Minimum of 8 to 10 years of leadership experience in healthcare and/or managed care.

  • Proven success in supporting Medicaid, Medicare, Dual Eligible Special Needs Plans or other government programs by leveraging strong knowledge and expertise in strategy development, product management, financial performance, compliance, and relationship management. Must be committed to health equity and improving health outcomes and experience for the Medicaid population.

  • Excellent presentation and interpersonal skills are essential.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Fallon Health Vaccination Requirements:

To protect the health and safety of our workforce, members and communities we serve, Fallon Health now requires all employees to disclose COVID-19 vaccination status. As of 2/1/2022 all roles not designated as “Remote” require full COVID-19 vaccination (booster IS NOT required) and Fallon Health will obtain the necessary information from candidates prior to employment to ensure compliance. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.


Location US-MA-Worcester

Posted Date 2 weeks ago (3/13/2023 2:09 PM)

Job ID 7219

# Positions 1

Category Senior Leadership