Sr. Medical Dir, MassHealth

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.

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 MassHealths value-based care programming including related to quality measurement and clinical performance
• Oversee clinical quality improvement initiatives for MassHealths 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

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