PCM Program Director

Care Remedy is seeking an experienced and highly organized PCM Program Director to lead the development, implementation, and day-to-day operations of our MassHealth Personal Care Management (PCM)/PCA Program .

The PCM Program Director will provide leadership across our Woburn, Brockton, and Springfield offices and will be responsible for building a strong, compliant, and scalable PCM program.

This is a hands-on leadership position. The Director will oversee consumer enrollment, assessments, prior authorizations, Functional Skills Training, reevaluations, documentation, staff performance, quality assurance, and billing readiness.

The ideal candidate understands Massachusetts community-based healthcare and can build systems, develop staff, solve operational problems, and ensure services are delivered and documented according to MassHealth requirements.

Key Responsibilities

• Lead the development and daily operation of Care Remedy's PCM/PCA program.

• Oversee PCM operations across the Woburn, Brockton, and Springfield branches .

• Recruit, hire, train, supervise, and evaluate PCM staff.

• Provide leadership to Skills Trainers, RNs, OTs, Care Coordinators, and administrative/support staff .

• Oversee new consumer intake, enrollment, assessments, evaluations, and ongoing PCM services.

• Ensure assessments, Functional Skills Training, reevaluations, service agreements, and other required activities are completed accurately and on time.

• Oversee prior authorization submissions, extensions, modifications, renewals, and terminations .

• Ensure consumer and surrogate information is properly documented and maintained.

• Monitor required documentation, progress notes, assessments, and supporting records.

• Ensure compliance with applicable MassHealth PCM/PCA requirements, HIPAA, EVV, e-CAS, and organizational policies .

• Develop workflows, policies, procedures, checklists, and quality-control systems for the PCM department.

• Establish consistent PCM processes across all three Care Remedy offices.

• Work closely with Finance and Billing to ensure services are properly authorized, documented, submitted, and billable .

• Identify and resolve missing documentation, authorization issues, billing discrepancies, and operational problems.

• Monitor consumer enrollment, assessment completion, authorization status, staff productivity, billing readiness, and other key performance indicators.

• Conduct regular PCM staff meetings and provide training, coaching, and performance feedback.

• Prepare the PCM program for MassHealth reviews, audits, and other compliance activities.

• Develop corrective action plans when compliance or operational issues are identified.

• Build relationships with consumers, families, healthcare providers, community organizations, and referral partners.

• Support responsible growth of Care Remedy's PCM/PCA consumer population throughout Massachusetts.

• Provide regular reports to executive leadership regarding enrollment, staffing, compliance, authorizations, billing, and program performance.

Qualifications

• Master's degree in healthcare administration, nursing, social work, human services, business administration, or a related field preferred.

• 3–5+ years of healthcare, home and community-based services, PCA/PCM, case management, disability services, or related program-management experience preferred.

• Previous supervisory or management experience required.

• Massachusetts MassHealth PCM/PCA experience strongly preferred.

• Experience supervising multidisciplinary teams is highly desirable.

• Strong understanding of healthcare documentation, compliance, quality assurance, and program operations.

• Experience with prior authorizations, assessments, electronic case-management systems, EVV, or healthcare billing workflows preferred.

• Strong leadership, communication, organizational, and problem-solving skills.

• Ability to manage multiple priorities and deadlines across multiple locations.

• Comfortable using technology and learning electronic healthcare and case-management systems.

What We Are Looking For

We are looking for a builder and leader , not simply an administrator.

The successful candidate should be able to take ownership of the PCM program, build an effective team, establish reliable processes, maintain strong compliance standards, identify problems before they affect billing or consumer services, and help Care Remedy responsibly expand its PCA/PCM program.

The Director will work closely with Care Remedy's executive, clinical, operations, technology, finance, and billing teams to build a high-performing PCM program.

Compensation

$70,000–$110,000 per year , depending on qualifications and relevant PCM/PCA leadership experience.

• Job Type: Full-time
• Primary Office: Woburn, Massachusetts
• Additional Program Oversight: Brockton and Springfield, Massachusetts

Care Remedy Inc. is an Equal Opportunity Employer.

Pay: $70,000.00 - $114,000.00 per year

Benefits

• Flexible schedule

• Paid time off

Work Location: In person