University of Massachusetts Medical School

Medical Director, MassHealth Long Term Services & Support

Minimum Salary US-MA-North Quincy
Job Location 4 months ago(10/27/2020 11:40 AM)
Requisition Number
2020-35785
# of Openings
1
Posted Date
Day
Shift
Exempt
Exempt/Non-Exempt Status
Non Union Position -W60- Non Unit Professional

Overview

POSITION SUMMARY:

 

The Medical Director, MassHealth Long Term Services & Support reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA) and works directly with the MassHealth Chief of Office of Long Term Services and Support(OLTSS) and Secretary of the Executive Office of Elder Affairs (EOEA), as well as collaborates with Commissioners of the Departments of Mental Health(DMH), Developmental Disabilities (DDS) , and the Massachusetts Rehabilitation Commission (MRC). Serves as a clinical resource for OCA and EOHHS programs as well as MassHealth providers and will focus on developing innovative approaches for improving the quality, efficiency, and appropriateness of care delivered to MassHealth members.  Develops creative approaches to enhancing the principles of independent living and consumer direction.  Serves as a thought leader on LTSS population health management and the integrated health model, with an eye towards system-wide value enhancements that improve the health equity of MassHealth members, especially through the implementation of best practices and technological solutions or other enhancements.

Responsibilities

ESSENTIAL FUNCTIONS:

  • Serve as the clinical lead for all quality, clinical, survey and certification, and policies for MassHealth LTSS delivery models, including fee-for-services program, HCBS waiver programs, and integrated care organizations (One Care, SCO, PACE).
  • 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 LTSS provider and plan network.
  • Develop, test, evaluate, adopt and support performance measurement systems (i.e., quality measures) to evaluate care provided to MassHealth LTSS members enrolled in a variety of service delivery systems ranging from fee-for-service to integrated care organizations to ACO plans.
  • Lead the specification and operational refinement of a uniform core assessment tool and an integrated independent assessor framework that operates across LTSS delivery systems.
  • Collaborate and partner on a day-to-day basis with the Executive Office of Elder Affairs (EOEA) to focus on key areas such as, but not limited to:
    • Lengthening the ability for persons with disabilities and older populations to age in community by strengthening the care continuum, with particular emphasis on the integration of medical care with community or home-based services;
    • Developing and supporting programs that address accelerated cognitive, physical, or emotional decline in older populations due to social isolation;
    • Taking into consideration the needs of older adults and individuals of all ages with disabilities when developing new, or modifying existing LTSS programs;
    • Provide a clinical perspective on service development.
  • Partner with MassHealth and EOEA, with input and collaboration from DDS, DMH, and MRC, to develop a care continuum that coordinates, streamlines, and strengthens home and community-based supports for their MassHealth LTSS members.
  • Research and propose innovative approaches for improving the quality, efficiency, and appropriateness of care delivered by MassHealth fee-for-service providers and programs, and contracted integrated care organizations (One Care, SCO and PACE) and seek out best practices and technological solutions or other enhancements.
  • Collaborate and form working relationships with MassHealth sister agencies integral to supporting LTSS members, specifically the Executive Office of Elder Affairs (EOEA), Department of Developmental Services (DDS), Department of Mental Health (DMH), and Massachusetts Rehabilitation Commission (MRC).
  • Collaborate with key LTSS stakeholders, including ILCs, ASAPs, and contracted integrated care organizations to support their efforts to ensure an integrated LTSS care continuum that aims to improve utilization and outcomes, quality of care, social determinants of health, and member experience for MassHealth LTSS members.
  • Communicate, educate, and develop partnerships with contracted providers and integrated care plans, and provide medical guidance and support to program teams around LTSS initiatives.
  • Provide thought leadership and consulting expertise on population health management approaches and metrics specific to the LTSS population with a strong lens on intersecting behavioral health needs.
  • Assist the CMO of MassHealth and Chief of OLTSS with the development and implementation of a holistic strategy to clinical, quality, reimbursement and analytics initiatives.
  • Provide clinical support and expertise focusing on LTSS to OCA and EOHHS programs and clinical staff.
  • Participate in OCA activities to monitor, report upon, and make recommendations regarding quality, clinical effectiveness and cost effectiveness of MassHealth LTSS services and programs.
  • Participate in or lead stakeholder and Advisory Board meetings and other OCA, MassHealth and EOHHS meetings as designated by OCA Director or the MassHealth Chief of OLTSS.
  • Build and maintain effective working relationships with cross-functional leaders and teams in order 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

REQUIRED EDUCATION:

 

M.D. or D.O. with Board Certification required, and actively licensed to practice medicine without restriction in Massachusetts throughout his/her employment with OCA.

 

REQUIRED WORK EXPERIENCE:

  • 5 - 7 years of experience in direct patient care preferably focusing on populations that require LTSS, additional managerial experience preferred.
  • Understands incentives and disincentives across patient care settings for integrated care plans, fee-for-service models, and Medicaid waiver programs.
  • Experienced in applying principles of population health management into clinical and community-based settings.
  • Experienced in developing, implementing, or evaluating programs that deliver a combination of medical and home or community-based services.
  • Served in a senior role in designing or implementing programs intended to reduce costs and improve clinical and non-clinical quality outcomes.
  • Experienced clinician and a thought leader on the needs of populations requiring long term services and supports (LTSS), with a strong passion for better integrating an individual’s medical services with an individual’s social and behavioral health services.
  • Demonstrated ability to change entrenched clinical workflows.

PREFERRED WORK EXPERIENCE:

  • Collaborative leader with experience in developing and implementing innovative programs to improve quality of care provided to disabled and/or elderly populations
  • Working in or familiarity with managed care organizations (e.g. PACE, SCO, or Integrated Care Organizations (ICOs)) serving these populations, including familiarity with long-term and other community services that support them
  • Experience in implementation of bundled payments or other alternative payment models in a provider setting
  • Experience in providing treatment or care to complex populations ranging from children to older adults. A Master’s degree in business, healthcare administration, public health, public policy or equivalent degree, is desirable
  • Demonstrated ability to lead and manage in a matrixed organization and to execute and drive results
  • Excellent oral and written communication skills as well as presentation skills
  • Ability to deal with complex and rapidly changing environment.
  • Strong leadership and organizational skills.
  • Knowledge and understanding of managed care operations.

Additional Information

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