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GENERAL SUMMARY OF POSITION: 

The Medical Director for the MassHealth Payment and Care Delivery reform initiatives supports the MassHealth Accountable Care Organization (ACO) and other alternative payment initiatives.  The Medical Director for MassHealth Payment and Care Delivery Innovation reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA), but will work directly with the MassHealth Director of Payment and Care Delivery Innovation.  As an integral part of this role, the Medical Director for MassHealth Payment and Care Delivery Innovation 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.

MAJOR RESPONSIBILITIES:

• Serve as the focal point for all quality, clinical, survey and certification, and policies for MassHealth ACO models.
• 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 payment and care delivery innovation initiatives, including ACOs.
• Develop, test, evaluate, adopt and support performance measurement systems (i.e., quality measures) to evaluate care provided to MassHealth members enrolled in ACO models
• Lead the specification and operational refinement of an integrated quality information system for MassHealth ACO program.
• Research and propose innovative approaches for improving the quality, efficiency, and appropriateness of care delivered by MassHealth contracted ACOs and seek out best practices and technological solutions or other enhancements.
• Collaborate with contracted ACOs to support their efforts to improve utilization, quality of care, member experience, affordability, medical documentation, etc. for MassHealth members attributed to ACOs.
• Communicate, educate, and develop partnerships with contracted ACOs and serve, when needed, as the interface between MassHealth and providers around ACO implementation.
• Provide thought leadership and consulting expertise on population health management approaches and metrics.
• Assist the Director of OCA and Director of Payment and Care Delivery Innovation with the development and implementation of a holistic strategy to clinical, quality and analytics initiatives.
• Provide clinical support and expertise 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 medical services and programs.
• Participate in or lead Advisory Board meetings and other OCA, MassHealth and EOHHS meetings as designated by OCA Director or the MassHealth Director of Payment and Care Delivery Innovation.
• 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.

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 in ABMS recognized specialty with at least 3 years of experience in direct patient care.

PREFERRED QUALIFICATIONS:

• Experience in implementation of bundled payments or other alternative payment models in a provider setting
• A Master’s degree in business, healthcare administration, public health, public policy or equivalent degree, is highly desirable
• Collaborative leader with experience developing and implementing innovative clinical programs
• 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

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