Senior Program Manager, MassHealth Quality Programs OCA

Overview

Under the general direction of the MassHealth Chief Medical Officer/Director of OCA, or designee, the Senior Program Manager works directly with the MassHealth Quality Office and MassHealth Program leadership in the development and implementation of a cohesive approach to measuring and promoting quality, equity, and patient experience for MassHealth members.

Responsibilities

ESSENTIAL FUNCTIONS

Quality Program Strategy and Design

Lead, in partnership with MassHealth program teams (including the MassHealth Office of Behavioral Health, the MassHealth Office of Long-Term Services and Supports, and the Office of Provider and Pharmacy Programs), strategy and design of quality programs including for behavioral health providers, Integrated Care Programs, and acute hospitals
Lead, in partnership with MassHealth program teams, programmatic strategy and design including related to: Selection of quality and health equity measures; Setting of performance targets; Establishing and testing performance assessment methodologies; Maintaining and updating contractual and regulatory documents to accurately reflect quality program design
Together with MassHealth Quality Office leaders, contribute to the development and ongoing maintenance of the MassHealth Quality Strategy
Regularly report to OCA leadership and staff (and other entities, at OCA leadership direction) on the status of MassHealth quality and health equity measurement programs and progress towards quality and health equity priorities.

Quality Program Implementation and Monitoring

Lead, in partnership with MassHealth program teams, implementation of MassHealth quality and health equity measurement programs including for behavioral health providers, long-term services and supports including those delivered through Integrated Care Programs, and acute hospitals
Monitor and analyze quality and health equity measurement program performance
Lead performance remediation processes, as applicable
Monitor, analyze, and report on quality and health equity measure performance
Lead and/or support program teams in developing and implementing quality and health equity performance management activities
Manage necessary quality analytics resources to support MassHealth quality and health equity program functions, including by coordinating and overseeing inputs from OCA and MassHealth data and analytics staff

Quality Stakeholder Engagement

Lead stakeholder engagement and education activities with external stakeholders (providers, health system representatives, federal authorities including CMS) through activities such as leading regular office hours, maintaining stakeholder requests, and through other venues as assigned
Manage negotiations with CMS, as needed, to support continued authority for quality and health equity measurement programs
Lead and/or support relevant MassHealth program advisory groups, including by preparing materials, managing activities, and being accountable for necessary follow-up activities
Engage with contracted vendors, as appropriate, on MassHealth quality and health equity measurement program-specific deliverables

Cross-Cutting Quality Initiatives

Serve as a subject matter expert for MassHealth quality and health equity measurement programs
Contribute to design and implementation of cross-cutting quality initiatives that impact multiple programs within MassHealth, including related to health equity and member experience

Hire, advise and directly supervise and evaluate performance of other staff. Provide functional supervision of other specific project/program staff as needed. Review and monitor compliance with the federal and state regulations. Perform other duties as required.

Qualifications

REQUIRED EDUCATION

Master's Level Degree in Health Care or Business Administration, Public Health, or a quality related health care field.

REQUIRED WORK EXPERIENCE

5 – 7 years of experience leading health care quality measurement and performance programs. Experience with acute hospital quality measurement. Experience with behavioral health quality measurement and/or long-term-services or supports quality measurement. Experience in a recent management/supervisory role. Excellent communication and presentation skills, both oral and written, to interact with leadership, staff, providers and other stakeholders.

PREFERRED WORK EXPERIENCE

Experience with quality measurement in ambulatory and inpatient settings. Experience with Medicaid quality measurement programs. Experience with health equity measurement. Experience with quality measure development. Quality analytics experience, including use of Medicaid claims data. Flexibility and ability to thrive in a fast-paced, dynamic environment.

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