Senior Medical Director, MassHealth

Overview

Under the general direction of the Director of the Office of Clinical Affairs (OCA)/Chief Medical Officer or designee, the Sr. Medical Director MassHealth will serve as a clinical expert resource for OCA and MassHealth programs and MassHealth providers. The Senior Medical Director will lead key areas related to clinical policy and programs; population health, quality and health equity; stakeholder engagement; medical management; and management and staff development to improve health, quality, equity, efficiency, and appropriateness of care for MassHealth members.

Responsibilities

Clinical Strategy, Policy, and Programs

• Serves as a senior clinical leader for OCA and MassHealth programs
• Leads development and implementation of clinical policies and programs for MassHealth
• Leads development and implementation of innovative approaches for improving the quality, efficiency, and appropriateness of care delivered to MassHealth members
• Closely collaborates with one or more program teams at MassHealth to meet their clinical policy and programs needs
• Provides clinical support and expertise to OCA and EOHHS programs and clinical staff to inform MassHealth policies and programs
• Provide clinical expertise and engagement to support prompt and responsive resolution to clinical case escalations
• Participate in OCA activities to monitor, report upon, and make recommendations regarding the quality, clinical effectiveness, and cost-effectiveness of MassHealth medical services and programs.
• Holds accountability for designing and implementing effective MassHealth clinical policies and programs that meet the needs of MassHealth
• Ensures clinical policies and programs are compliant with relevant state and federal requirements

Population Health, Quality, and Health Equity Policy and Programs

• Provide leadership in the development and implementation of a cohesive approach to promoting high quality, equitable, efficient, and appropriate clinical care for MassHealth members
• Serves as a clinical subject matter expert informing MassHealth’s value-based care programming, including related to quality measurement and clinical performance
• Oversee clinical quality improvement initiatives for MassHealth’s programs
• Support development, implementation, and evaluation of clinical performance measurement programs for MassHealth programs
• Develop and implement strategies to improve clinical and population health outcomes for MassHealth members

Stakeholder Engagement

• Collaborate with and serve as a clinical liaison for MassHealth plans and providers to support their efforts to improve high quality, equitable, efficient, and appropriate clinical care for MassHealth members.
• Communicate and coordinate with contracted plans and providers and serve, when needed, as the clinical liaison between MassHealth and plans and providers serving MassHealth members.
• Lead internally- and externally-facing OCA, MassHealth and/or EOHHS meetings
• Build and maintain effective working relationships with cross-functional leaders and teams within MassHealth and EOHHS to identify, explore, present and implement clinical strategy, policies and programs
• Establish and maintain collaborative relationships with external stakeholders, including plans and providers as well as community organizations and other stakeholders
• Establish and maintain collaborative, productive relationships with federal partners and authorities

Medical Management

• Oversee components of MassHealth medical management strategy, programs and/or policies
• Participate in medical management activities, such as prior authorization reviews and clinical policy development

Leadership

• Provide clinical leadership and mentoring for OCA and MassHealth staff and work collaboratively with both clinical and non-clinical team members.
• Supervise approximately 3-5 clinical and/or non-clinical staff
• Support the experience of trainees and other rotators at MassHealth, including clinical trainees
• Perform other similar and related duties as required or as directed

Qualifications

• Medical Doctor or Doctor of Osteopathy.
• Actively licensed to practice medicine without restriction in Massachusetts throughout employment with OCA.
• Board-certified in an ABMS recognized specialty; may be Board-eligible upon employment but must be Board-certified within one year of hire.
• At least 7 years of policy/population health/public health experience; relevant experience before or during medical training may be taken into consideration.
• Excellent oral and written communication and presentation skills
• Must work 2 days per week on site in Boston and/or Quincy during normal business hours
• Proven ability to develop and successfully implement strategic initiatives.

Preferred Qualifications

• Experience delivering medical care in clinical settings across the continuum of care.
• Demonstrated commitment to serving MassHealth and/or other Medicaid populations