SEARCH CAREER OPPORTUNITIES

Commonwealth Medicine is the health care consulting division of UMass Medical School, Massachusetts’ only public medical school. As a nationwide leader in the development and implementation of health care reform, Commonwealth Medicine stays ahead of health care trends and helps strategize and plan for changes that impact both health care delivery systems and patients.  Applying academic research to make evidence-based recommendations, Commonwealth Medicine supports government agencies, nonprofits, and managed care organizations to meet today’s health care challenges and to prepare for what’s to come.

Commonwealth Medicine’s Office of Clinical Affairs (OCA) provides clinical leadership to MassHealth, the Massachusetts Medicaid program. This includes a full range of medical management functions, such as clinical policy, utilization management, pharmacy, quality, clinical informatics and oral health on behalf of MassHealth programs. Working closely with MassHealth, we ensure that patients receive medically necessary, appropriate, cost-effective, quality care in compliance with state and federal regulations.

We are seeking a Director of Dental Services (Dental Director) to oversee the MassHealth dental program within MassHealth. The Dental Director works on access, oral health prevention activities, and other initiatives to address oral health disparities, including but not limited to workforce shortages.

The Dental Director is a representative of and spokesperson for the MassHealth dental program, participates on various committees, and provides outreach to dentists in the Commonwealth. The Dental Director leads the MassHealth Dental Advisory Committee, chairs applicable joint committees, and consults with the Center for Health Information and Analysis regarding dental rate development.  The Dental Director is a senior expert on oral health and health care in the Executive Office of Health and Human Services, providing advice, guidance, consultation and expertise to policy makers throughout state government.

Under the leadership of Carolyn S. Langer, MD, JD, MPH, CPE, the Chief Medical Officer of MassHealth, the Dental Director will provide clinical oversight to the Management of the MassHealth Dental Program within MassHealth.  This highly visible role will give you a unique and exciting opportunity to determine clinical policy and develop programs to improve the oral health care for MassHealth members, including developing and implementing strategies to increase access, improve quality, contain costs and eliminate racial and ethnic disparities.. You will also:

• Collaborate with the leadership at DPH and the DPH Office of Oral Health, as well as other Executive Office of Health and Human Services agencies, on dental health and public health programs, facilitating the integration of programs to improve the oral health of MassHealth recipients.
• Provide consultation to executive and other staff on oral health policy issues, new and emerging oral health procedures and technologies, dental program organizational goals, vendor management and any other activities to improve access and quality of oral health care to MassHealth members.
• Develop and implement oral health clinical standards, evidence-based clinical guidelines, best practices, algorithms and metrics to improve the oral health care delivered to MassHealth members.
• Review and provide input into MassHealth dental program policy and MassHeatlh regulations for MassHealth dental providers in order to ensure effective operations.
• Provide clinical leadership in the management of the dental third-party administrator contract.
• Review and provide input to guidelines for medical necessity determinations established by the dental third party administrator.
• Review and assess appeal decisions and strategize and implement methods to reduce the incidence of appeals and improve program efficiencies.
• Conduct prior authorization reviews, as appropriate, and represent MassHealth at appeals hearings, when requested.
• Review and analyze utilization data in order to evaluate effectiveness of dental program policies in meeting Executive Office of Health and Human Services’ (EOHHS’) objectives, including activities of the dental third-party administrator, and make recommendations for changes in dental policies, procedures, guidelines, etc.
• Prepare or oversee the preparation of reports for use in the dental program for monitoring, program evaluation, and reporting on dental remediation efforts.
• Provide clinical consultation, training, and dissemination of information regarding oral health care quality management and clinical evaluation within EOHHS and the OCA.
• Market and promote enrollment in the MassHealth dental program to the dental provider community.
• Lead the MassHealth Dental Advisory Committee comprising MassHealth-participating dentists and other dental providers.
• Provide consultation to the Provider Compliance Unit and other agencies to identify and investigate aberrant billing practices, fraud, waste or abuse.
• Make presentations at dental conferences, Massachusetts Dental Society (MDS) meetings, regional provider meetings, dental advocacy group meetings, and other relevant stakeholder meetings.
• Attend MassHealth, OCA, Center for Health Policy & Research, and Commonwealth Medicine (CWM) Leadership Team meetings.
• Attend and participate in Academic, OCA, and Providers and Plans meetings as directed.
• Perform other duties and responsibilities as required.

REQUIRED QUALIFICATIONS:

• Actively licensed to practice dentistry in Massachusetts without restriction throughout employment.
• Possess a minimum of seven years recent clinical experience that includes experience in public health.
• Previous management experience within an organization providing oral health care.
• Possess experience in quality management theory and practice.
• Demonstrated strong written and verbal communication skills, as well as strong interpersonal skills.
• Possess strong analytic skills. 

PREFERRED QUALIFICATIONS:

• Be knowledgeable in recent advances and changes in the dental industry.
• Utilization management/prior authorization experience and knowledge of dental coding/billing practices is desirable
• Experience serving diverse and/or low income populations.
• Knowledge of Medicaid policies, particularly those pertaining to the Medicaid dental program and its regulations.
• Advance training or graduate degree in management or public health desirable. 

This position is located in Quincy, just south of Boston, Massachusetts.

Why join Commonwealth Medicine’s Office of Clinical Affairs? You can be a part of UMass Medical School’s leading academic health sciences center where we make a difference every day in the lives of individuals as we develop, recommend and administer clinical policies for MassHealth. We offer a very competitive compensation and benefits package, free tuition at any Massachusetts state school and a place where cutting edge and pioneering health care services programs are developed and managed.

You will also have the opportunity to work with Dr. Carolyn Langer, an accomplished physician executive with over fifteen years of managed care experience, including positions at Harvard Pilgrim Health Care, Fallon Community Health Plan, Blue Cross Blue Shield of Massachusetts, the Tufts Health Care Institute and ManagedComp.  Dr. Langer is also an Instructor at the Harvard School of Health,  as well as a retired Colonel and former flight surgeon in the Army National Guard.

If you are a high-energy individual who is passionate about helping vulnerable populations and loves the challenge of working in a fast-paced entrepreneurial environment, you are encouraged to submit your credentials for further consideration.

*LI-LH1