Sr. Medical Director

Under the general direction of the Director of the Office of Clinical Affairs (OCA)/Chief Medical Officer or designee, the Sr. Medical Director MassHealth:

• Supports the designated MassHealth programs such as Payment and Care Delivery Innovation.
• Develops, implement and support program and policies to improve clinical performance through MassHealth Accountable Care Organization (ACO), Managed Care Organization (MCO), Community Partner (CP), and other alternative payment initiatives.
• Reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA).
• Serve as a clinical resource for OCA and EOHHS programs as well as MassHealth providers and will focus on innovative approaches for improving the quality, efficiency, and appropriateness of care delivered to MassHealth members.
• Serves as a thought leader on population health management and the integrated health model, with an eye towards system-wide value enhancements through the institution of best practices and technological solutions or other enhancements.

Responsibilities

• Provide leadership and coordination for the development and implementation of a cohesive approach to measuring and promoting quality and lead priority-setting process for clinical quality improvement for MassHealth’s payment and care delivery innovation initiatives, including ACOs, MCOs and CPs.
• Develop, test, evaluate, adopt and support performance measurement systems (i.e., quality measures and health equity initiative) to evaluate care provided to MassHealth members enrolled in ACO models.
• Research and propose innovative approaches for improving the quality, efficiency, and appropriateness of care delivered by MassHealth contracted ACOs, MCOs and CPs and seek out best practices and technological solutions or other enhancements.
• Collaborate with contracted ACOs, MCOs and CPs to support their efforts to improve utilization, quality of care, member experience, affordability, medical documentation, etc. for MassHealth members attributed to ACOs.
• Communicate, educate, and develop partnerships with contracted ACOs, MCOs and CPs and serve, when needed, as the interface between MassHealth and providers around ACO and CP implementation.
• Serve as the focal point for all quality, clinical, survey and certification, and policies for MassHealth ACO, MCO and CP models.
• Proposes and leads process improvement plans to improve efficiency and reduce waste.
• Provide thought leadership and consulting expertise on population health management approaches and metrics.
• Assist the Director of OCA and Chief of Payment and Care Delivery Innovation with the development and implementation of a holistic strategy for clinical, quality, and analytics initiatives.
• Provide clinical support and expertise to OCA and EOHHS programs and clinical staff, especially for situations requiring immediate response, including crisis management.
• 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.
• Participate in or lead Advisory Board meetings and other OCA, MassHealth and EOHHS meetings as designated by OCA Director or the MassHealth Director of Payment and Care Delivery Innovation.
• Build and maintain effective working relationships with cross-functional leaders and teams to identify, explore, present and implement clinical opportunities.
• Provide clinical leadership and mentoring for OCA and MassHealth staff and work collaboratively with both clinical and non-clinical team members.
• Perform other similar and related duties as required or as directed.

Qualifications

Education(Required)

• Medical Doctor or Doctor of Osteopathy.
• Actively licensed to practice medicine without restriction in Massachusetts throughout his/her employment with OCA.

Work Experience(Required)

• Board certified in a ABMS recognized specialty with at least 10 years of Policy/Population Health/Public Health experience post residency.
• Experience in serving diverse clinical community settings across the continuum of care is required.
• Excellent oral and written communication and presentation skills including proficiency with Microsoft , Excel and Powerpoint.
• Must work 1-2 days onsite in Boston and/or Quincy during normal business hours (this position is currently Hybrid).
• Proven ability to develop and successfully implement strategic initiatives.