The Director of Quality and Equity for MassHealth supports the Office of Clinical Affairs and MassHealth teams in the development and implementation of quality and equity programs including a broad range of quality measures to ensure compliance and promote quality for all applicable stakeholders, including state, federal, Accountable Care Organizations (ACOs), Managed Care Organizations (MCOs), acute hospitals, and members. The Director of Quality and Equity MassHealth reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA) or their designee. Provides leadership in the development, implementation, and management of quality and equity programs with robust reporting mechanisms and performance improvement related to a broad range of ACO, MCO, and acute hospital-related quality activities. Serves as a thought leader on population health management as relates to quality and performance improvement.

• In conjunction with MassHealth leadership, responsible for the development and ongoing implementation and evolution of robust reporting mechanisms to track, monitor and report on MassHealth health quality- related performance (i.e., aggregate and disaggregated quality of care, access, member experience measures.)
• Design, implement and maintain MassHealth quality and equity programs.
• Convene MassHealth and OCA teams as relevant to provide ongoing input on quality and equity programs and to ensure alignment with MassHealth quality programs and strategy.
• Design, implement and maintain a robust strategy for measuring quality of care, utilization, and member experience for MassHealth entities including ACOs and MCOs.
• Monitor performance on quality of care, utilization, and member experience measures.
• Analyze quality and equity data in service of program goals.
• Design and implement a quality and equity reporting strategy for internal and external stakeholders in order to:
• Publicly report on quality and equity performance in accordance with applicable regulatory and other requirements.
• Inform MassHealth program and policy development and implementation.
• Support performance management of accountable entities in collaboration with MassHealth contract management staff and teams.
• Lead the development and implementation of MassHealth’s internal and external processes and practices for development of quality and equity improvement goals and strategies and implementation of quality and equity improvement action plans for accountable entities in collaboration with MassHealth clinical, contract management, and quality teams as well as with MassHealth providers.
• Lead communication with external stakeholders on quality and equity programs.
• Represent MassHealth on external stakeholder groups related to MassHealth quality and equity programs and lead development of related materials and communications.
• Partner with MassHealth Quality Team and MassHealth contracted vendors to comply with annual and other CMS quality reporting and improvement processes as required for MassHealth plans.
• Stay current on regulatory environment; serve as internal consultant to provide guidance and input on all matters concerning clinical compliance and regulation; implement, and sustain efficient methods of assuring consistent compliance with all relevant regulatory and quality monitoring requirements.
• 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.

Required Education:

• A graduate degree in public health or public policy or other advanced degree in business or healthcare

Required Experience:

• At least seven (7) years of full-time, or equivalent, experience working in healthcare quality and/or equity measurement, healthcare quality and/or equity program implementation, and/or healthcare quality and/or equity improvement initiatives
• At least five (5) years Of full time or, equivalent part-time, experience serving in a supervisory or managerial capacity
• Demonstrated skills of developing, implementing, and evaluating quality and performance initiatives, including related to data collection and analysis
• Demonstrated expertise in local, regional, and/or national quality measurement areas including state/federal regulations related to healthcare quality
• Experience working with health care quality measures such as those employed by the Joint Commission, CMS, AHRQ, or health care systems
• Demonstrated understanding of MassHealth innovations related to accountable care.
• Flexibility and ability to thrive in a fast-paced, dynamic environment.
• 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

Preferred Work Experience:

• Demonstrated understanding of the current MassHealth ACO and MCO programs.
• Experience developing quality measures for health care.
• Working knowledge of complex federally funded innovative payment model projects and/or experience working in a Medicaid health system or provider group setting.