The Associate Medical Director (AMD) for the MassHealth Payment and Care Delivery reform initiative supports the MassHealth Accountable Care Organization (ACO) and Managed Care Organization Programs. Under the direction of the Director of the Office of Clinical Affairs (OCA) or his/her designee, this AMD is responsible for providing clinical expertise to OCA and EOHHS. The AMD will 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. He/She 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.
Provide clinical support and subject matter expertise to OCA programs and clinical staff, and provide clinical survey and certification and policies for MassHealth ACO and CP models.
Provide leadership and support for the development and implementation of a cohesive approach to measuring and promoting quality and support priority-setting process for clinical quality improvement for MassHealth's payment and care delivery innovation initiatives, including ACOs and MCOs.
Collaborate with ACOs and MCOs to support their efforts to improve utilization, quality of care, member experience, affordability, medical documentation, etc. for MassHealth members attributed to ACOs and MCOs.
Assist the Director of OCA or designee,and the Chief of Payment and Care Delivery Innovation with the development and implementation of a holistic strategy to clinical, quality and analytics initiatives.
Provide clinical leadership to the activities of medical program managers.
Provide updates and consult with OCA and MassHealth managers on new technologies, treatment methodologies and policies.
Participate in communications with MassHealth medical providers, conduct peer-to-peer discussions, as applicable, and educate physicians and others on current policy.
Participate in or lead Advisory Board meetings and other OCA, EOHHS and Office of Medicaid meetings as designated by OCA Director or his/her designee.
Assist the Director of OCA and the Medical Directors with the development and implementation of clinical, quality and analytics initiatives. Participate in OCA activities to monitor, report upon, and make recommendations regarding quality, clinical effectiveness and cost effectiveness of MassHealth medical services and programs.
Provide clinical leadership and mentoring for the OCA and MassHealth staff and work collaboratively with both clinical and non-clinical team members.
Build and maintain effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement clinical opportunities.
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 his/her employment with OCA
Board certified in area of specialty and minimum 5 years of experience in direct patient care
Must work onsite during normal business hours
Experience providing direct care to disabled populations or working in or with managed care organizations (e.g. ACO, PACE, SCO, or Integrated Care Organizations (ICOs)) serving these populations, including familiarity with long-term and other community services that support them
A graduate degree in Public Health or Public Policy or other advanced degree in business or healthcare is desirable.
Experience in the application of state and federal Medicaid rules and regulations.
University Of Massachusetts Medical School