University of Massachusetts Medical School

Dir, MassHealth Behavioral Health Quality

Job Location US-MA-Boston
Posted Date 3 weeks ago(2/23/2018 10:07 AM)
Requisition Number
# of Openings
Exempt/Non-Exempt Status
Union Code
Non Union Position -W60- Non Unit Professional



The Director of MassHealth Behavioral Health Quality supports the MassHealth Office of Behavioral Health (OBH) in the development and implementation of behavioral health quality measures to ensure compliance and promote quality for all applicable stakeholders, including state, federal, ACO contracts and member experience. The Director of MassHealth Behavioral Health Quality reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA), but will work under the general direction of the MassHealth Chief of Behavioral Health and Supportive Care or designee, and will work directly with the MassHealth Deputy Director of Behavioral Health.   The Director of MassHealth Behavioral Health Quality will serve as a thought leader on population health management and the integrated health model and will provide leadership in the development of robust reporting mechanisms and performance improvement related to behavioral health quality.



  • In conjunction with MassHealth leadership, responsible for the development and ongoing implementation and evolution of robust reporting mechanisms to track, monitor and report behavioral health quality-related performance (i.e., quality of care, access and member experience measures).
  • Maintain quality oversight of MassHealth members, including, but not limited to: 1) the Primary Care Clinician Plan—including the specialty behavioral health plan, the Massachusetts Behavioral health Partnership (MBHP); 2) MassHealth’s contracted Managed care entities (MCEs); 3) the integrated Medicaid and Medicare managed care plans, such as One Care, Senior Care Options & the Program of All-inclusive Care (PACE); 4) and members enrolled in Accountable Care Organization (ACO) models.
  • Recommend, develop, implement and sustain the most efficient methods of assuring consistent compliance with all current regulatory and quality monitoring requirements, including adverse incident reporting and HEDIS measurement.
  • Develop a Behavioral Health Quality Program description and dashboard, a Quality Evaluation Plan and a Quality Improvement Plan.
  • Convene OBH and cross-functional teams and provide overall direction to OBH quality management, including the development of work plans, quality measure slate design and analysis, and processes for monitoring and improvement.
  • Identify necessary resources to perform BH Quality Oversight, including organizing and coordinating resources from MassHealth; monitor work progress, including data analysis and reports.
  • Partner with MassHealth Quality Team and MassHealth contracted vendors to comply with annual CMS quality reporting and improvement processes as required for MassHealth plans.
  • Coordinate formal communications and meetings within MassHealth and with providers around quality and member experience performance and improvement opportunities. Summarize data findings into summary analysis presentations including recommendations for improvement.
  • Lead the development of OBH’s internal and external processes and practices for regular review of quality performance indicators, development of quality improvement goals and strategies, and implementation of QI action plans in collaboration with MassHealth MCE contract management and quality teams, MCE Behavioral Health and quality management leaders, as well as with MassHealth providers.
  • Stay current on regulatory environment; serve as internal consultant to provide guidance and input on all matters concerning clinical compliance and regulation.
  • Support OBH team in new program and policy development based on identified quality improvement opportunities.
  • Support case management and clinical review activities in collaboration with Office of Clinical Affairs staff, as needed;
  • Perform retrospective clinical review of claims and member records as required to support program integrity, compliance, and quality assurance activities
  • Collaborate with staff to effectively meet departmental goals.
  • Perform other duties as required.


  • Clinical background – Clinical Psychologist or Psychiatric Nurse Practitioner with demonstrated understanding of behavioral health levels of care, inclusive of Mental Health and Substance Use Services
  • 5 years or more of combined experience in clinical practice, health plan quality management, practice management & redesign, and/or health services evaluation
  • Demonstrated skills of developing, implementing and evaluating quality, including designing, commissioning, and overseeing data analyses pertaining to quality performance. initiatives
  • Experience working with and/or developing quality measures for behavioral health care, including relevant HEDIS, Joint Commission, CMS, AHRQ measures sets.
  • Working knowledge of complex federally funded innovative payment model projects and/or experience working in a Medicaid health system or provider group setting.
  • Flexibility and ability to thrive in a fast-paced, dynamic environment.
  • Ability to research and analyze state/federal regulations related to healthcare quality Familiarity with EOHHS mental health and substance use regulations, ED Boarding improvement initiatives, hospital quality, and/or behavioral health integration in primary care a plus.
  • Excellent communication and presentation skills, both oral and written, to interact with leadership, staff, providers and other stakeholders.
  • Competency in computer skills: Microsoft Word, Excel, PowerPoint and database software




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