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GENERAL SUMMARY OF POSITION: 

The Director of Quality for MassHealth Payment and Care Delivery Innovation (PCDI) supports the MassHealth PCDI team in the development and implementation of a quality program including a broad range of quality measures to ensure compliance and promote quality for all applicable stakeholders, including state, federal, ACO, MCO and Community Partners and members. The Director of Quality for Payment and Care Delivery Innovation reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA) or their designee. This position will work under the general direction of the MassHealth Chief of PCDI or their designee.   The Director of Quality for PCDI will provide leadership in the development, implementation, and management of a quality program with robust reporting mechanisms and performance improvement related to a broad range of ACO, MCO, and CP-related quality activities. They will also serve as a thought leader on population health management and the integrated health models as relates to quality and performance improvement.

MAJOR RESPONSIBILITIES:

• In conjunction with MassHealth leadership, responsible for the development and ongoing implementation and evolution of robust reporting mechanisms to track, monitor and report ACO and MCO health quality-related performance (i.e., quality of care, access and member experience measures).
• Maintain oversight of quality programs for MassHealth members, including, but not limited to: MassHealth’s contracted Managed care entities (MCEs) including ACOs and MCOs and Community Partners.
• Recommend, develop, implement and sustain the most efficient methods of assuring consistent compliance with all current regulatory and quality monitoring requirements
• Develop a PCDI Quality Program description and dashboard, a Quality Evaluation Plan and a Quality Improvement Plan in conjunction with the MassHealth Quality Office.
• Convene PCDI and cross-functional teams and provide overall direction to PCDI 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 PCDI 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 and other 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 PCDI’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 MCO and ACO 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 PCDI 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.

REQUIRED QUALIFICATIONS:

• Demonstrated understanding of the current ACO and MCO-offered services and the current local, regional, and national quality measurement areas.
• 5 years or more of combined experience in clinical practice, health plan or health system quality management, practice management & redesign, and/or health services evaluation
• Demonstrated skills of developing, implementing and evaluating quality and performance initiatives, including their design, commissioning, and oversight of data collection and analyses
• Experience working with and/or developing quality measures for health care such as HEDIS, Joint Commission, CMS, AHRQ, or other 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 including familiarity with the federal managed care rule.
• 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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