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POSITION SUMMARY:

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

ESSENTIAL FUNCTIONS:

• 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).
• Maintains quality oversight of MassHealth members receiving behavioral health care, 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.
• Recommends, develops, implements and sustains the most efficient methods of assuring consistent compliance with all current regulatory and quality monitoring requirements, including adverse incident reporting and Healthcare Effectiveness Data and Information Set (HEDIS) measurement.
• Stays current on clinical best practices for the delivery of behavioral health care; serve as an internal and external resource on such practices and use such awareness to inform monitoring compliance with clinical best practices in MassHealth behavioral health providers.
• Identify necessary resources to perform BH Quality Oversight, including organizing and coordinating resources from MassHealth; monitor work progress, including data analysis and reports.
• Coordinates 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.
• Supports OBH team in new program and policy development based on identified quality improvement opportunities.
• Supports case management and clinical review activities in collaboration with Office of Clinical Affairs staff, as needed. Demonstrate understanding of eligibility policies and practices of relevant EOHHS agencies (e.g., MassHealth, DCF, DYS, DDS, DMH) to enhance behavioral health care coordination and service delivery for MassHealth’s most complex members.
• Performs retrospective clinical review of claims and member records as required to support program integrity, compliance, and quality assurance activities.
• Collaborates with staff to effectively meet departmental goals.
• Perform other duties as required.

REQUIRED QUALIFICATIONS:

• Clinical background as a Licensed Clinical Psychologist or Licensed Independent Clinical Social Worker with demonstrated understanding of behavioral health levels of care, inclusive of Mental Health and Substance Use Services.
• 3 - 5 years 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 and compliance with applicable regulations and practices in a behavioral health treatment setting.
• 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.