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    Sr. Medical Director, MassHealth - Boston, MA, United States - University of Massachusetts Medical School

    University of Massachusetts Medical School
    University of Massachusetts Medical School Boston, MA, United States

    4 weeks ago

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    Description

    Under the supervision of the Director of the Office of Clinical Affairs (OCA)/Chief Medical Officer or assigned representative, the Senior Medical Director for MassHealth:

    • Supports specific MassHealth programs like Payment and Care Delivery Innovation.
    • Designs, implements, and backs programs and policies to enhance clinical performance in MassHealth Accountable Care Organization (ACO), Managed Care Organization (MCO), Community Partner (CP), and other payment initiatives.
    • Reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA).
    • Acts as a clinical reference for OCA and EOHHS programs and MassHealth providers, focusing on innovative strategies to enhance the quality, efficiency, and appropriateness of care for MassHealth members.
    • Position to lead in population health management and integrated health model discussions, emphasizing overall system value improvement through the establishment of best practices and technological solutions or other enhancements.

    Take charge of guiding and organizing the creation and execution of a unified approach for evaluating and advancing quality, and guiding the priority-setting process for clinical quality enhancement in MassHealth's payment and care delivery innovation ventures, encompassing ACOs, MCOs, and CPs.

    • Develop, assess, implement, and endorse performance evaluation systems (e.g., quality measures and health equity initiatives) to assess care given to MassHealth members enrolled in ACO models.
    • Research and suggest novel methods to enhance the quality, efficiency, and appropriateness of care offered by MassHealth contracted ACOs, MCOs, and CPs, and identify best practices and technological solutions or other improvements.
    • Collaborate with contracted ACOs, MCOs, and CPs to bolster their endeavors to enhance utilization, care quality, member experience, affordability, medical documentation, etc. Collaborate, educate, and build alliances with contracted ACOs, MCOs, and CPs and act as the intermediary between MassHealth and providers concerning ACO and CP implementation when required.
    • Serve as the central figure for all quality, clinical, inspection and certification, and policies related to MassHealth ACO, MCO, and CP models.
    • Formulate and manage process enhancement strategies to boost efficiency and reduce inefficiencies.
    • Offer innovative insights and consultancy on population health management methodologies and metrics.
    • Aid the Director of OCA and the Chief of Payment and Care Delivery Innovation in establishing and executing a comprehensive strategy for clinical, quality, and analytics initiatives.
    • Offer clinical support and expertise to OCA and EOHHS programs and clinical personnel, particularly for urgent situations, including crisis management.
    • Engage in OCA activities to oversee, report on, and propose measures regarding the quality, clinical effectiveness, and cost-effectiveness of MassHealth medical services and programs.
    • Deliver clinical leadership and guidance to OCA and MassHealth personnel and work collectively with both clinical and non-clinical team members.
    • Must hold an active unrestricted medical practice license in Massachusetts for the entirety of their term with OCA.
      REQUIRED EXPERIENCEBoard certification in an ABMS recognized specialty with a minimum of 10 years of Policy/Population Health/Public Health experience post residency.
    Experience in serving diverse clinical community settings across the care continuum is essential.
    Outstanding verbal and written communication and presentation abilities, including proficiency in Microsoft, Excel, and PowerPoint.
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