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
Find Your Best Opportunity
Tell them AcademicJobs.com sent you!
