Assoc Medical Director Aco/Mco

University Of Massachusetts Medical School Boston , MA 02298

Posted 3 months ago

Overview

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.

Responsibilities

MAJOR RESPONSIBILITIES:

  • 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.

Qualifications

REQUIRED QUALIFICATIONS:

  • 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

Additional Information

PREFERRED QUALIFICATIONS:

  • 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.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Director ACO Complex Care Management

Boston Medical Center

Posted 2 days ago

VIEW JOBS 1/23/2020 12:00:00 AM 2020-04-22T00:00 The Director, Complex Care Management oversees the Complex Care Management program implementation and staff across the Boston Medical Center Health System's (BMCHS) Accountable Care Organizations (ACO), which includes hospitals, primary care clinics, and community health centers across Massachusetts including the Greater Boston, Southeast MA, South Shore and Springfield/Holyoke areas. In close partnership with the Medical Director of Population Health Services, the Director will be responsible for setting a strategic vision for Complex Care Management and overseeing day-to-day operations of the program. He/she will maintain close monitoring of outcomes and performance data, be responsible for adjusting program design and implementation to achieve program goals, and be accountable for helping to drive quality outcomes. Additionally, the Director will continue to innovate and build programs and collaborations that enhance BMCHS's complex care management programs by leading efforts to develop targeted programs that impact the highest cost patients, such as a homelessness programs, clinical specialty programs (i.e. End Stage Renal Disease, Sickle-Cell Disease, palliative care), and other community collaborations that strengthen connections across the continuum of care. The Director will have the key responsibility for recruitment and retention of high-performing care management teams and will play a mission critical leadership role in interfacing with clinical sites to optimize integration of care management teams into existing clinical operations. * Care Management Program Management * Define key program elements for care management programs, including: patient selection criteria, care management workflows and processes, team role composition, staffing ratios, etc. * Centrally manage and implement a standardized care management program, but also understand the nuances of local clinical site dynamics and partner with local site leaders and existing local site programs to ensure program success * Define methods for measuring program success and demonstrating program effectiveness in managing total cost of care; partner with Clinical Analytics leads to define data and reports needed to manage performance * Care Management team leadership: * Hire, develop, and motivate Care Management Managers * Define recruitment and retention strategy to attract top care management talent across Massachusetts * Serve as key point person interfacing with local site leaders to ensure integration of care management teams into primary care practices and hospitals; design integration and onboarding plans for local CM teams, maintain open lines of communication with local site leaders * Develop partnerships with leaders across BMCHS, including Boston Medical Center Health Plan, Boston Medical Center, the Faculty Practice Foundation, and JV partners across Massachusetts * Metrics: Design programs and interventions targeted at key program outcomes, including * Reduction in ED and avoidable inpatient visits * Decreased total medical expense * Improved patient satisfaction * Improved clinical outcomes * Improved provider satisfaction * Other duties as assigned Education: * RN preferred, but Master's degree in a related health services field also considered Experience: * Extensive experience in clinical operations in a hospital, health system, provider practice, and/or community health center environment required * Experience building and leading complex care management programs * Experience building and managing a large team * A minimum of 10 years of management experience preferred Competencies, Skills, and Attributes: * Ability to partner with a variety of clinical sites, including community health centers, community hospitals, and academic medical centers where care management programs are deployed. * Excellent interpersonal skills and ability to work collaboratively across organizations and stakeholders * Ability to attract and develop top talent at the Manager and front-line level * Excellent written and verbal communication * Clinical operational experience * Advanced analytic abilities, including ability to define gaps and opportunities for improved performance and translate performance insights into operational actions * Business planning skills; ability to write clear and effective business plans for new programs * Ability to adapt to changes in healthcare delivery at local and systems level * Strong organizational and time management skills Boston Medical Center Boston MA

Assoc Medical Director Aco/Mco

University Of Massachusetts Medical School