SEARCH CAREER OPPORTUNITIES

POSITION SUMMARY:

The Associate Medical Director (AMD) for MassHealths Long Term Services & Supports (LTSS), under the direction of the Director of the Office of Clinical Affairs (OCA) or his/her designee, is responsible for providing clinical expertise to OCA and to the MassHealth program staff in the areas of LTSS. MassHealth, the Commonwealth of Massachusetts Medicaid Program, through its Office of LTSS (OLTSS) provides a robust system of care for members of all ages who need long-term care services to enable them to live with independence and dignity in their daily lives, participate in their communities, and increase their overall quality of life. Working closely with the MassHealth Chief of OLTSS, the Secretary of the Department of Developmental Disabilities (DDS) and other state agency commissioners such as the Massachusetts Rehabilitation Commission (MRC), Department of Mental Health (DMH) and Executive Office of Elder Affairs (EOEA), the LTSS AMD will provide strategic, policy, programmatic and leadership support around clinical management and LTSS integration. The LTSS will participate in the development and evaluation of clinical and quality standards and guidelines for MassHealth LTSS, and will serve as a clinical resource for OCA and MassHealth program staff as well as MassHealth providers and other key stakeholders. to develop innovative approaches for improving the quality (including patient experience), equity, efficiency, integrity and appropriateness of care delivered to MassHealth Members. The LTSS AMD will work to develop creative approaches towards enhancing the principles of independent living, person-centered care, equity and consumer direction. Further, the LTSS AMD will serve as a thought leader on LTSS population health management, and towards more integrated health delivery with an eye towards system-wide value enhancements and integration with other EOHHS agencies and programs to improve the health and health care for all MassHealth members requiring LTSS.

ESSENTIAL FUNCTIONS:

• Participate with the OCA Leadership and MassHealth program staff in strategic planning to develop and define long term clinical plans, strategies, and improvement opportunities, particularly around medical (including physical, behavioral and oral) health and LTSS integration.
• Serves as a clinical lead for MassHealth LTSS delivery models including fee-for-services program, HCBS waiver programs and integrated care (duals) health plans (One Care, PACE and SCO).
• Collaborate and partner closely with the Department of Developmental Services (DDS) to focus on key areas such as but not limited to:
• Strengthening the ability for persons with ID and DD to age into adulthood with particular emphasis on the integration of medical care with home and community-based services
• Taking into consideration the needs of children with disabilities when modifying existing or development of new LTSS programs
• Provide a clinical and provider perspective on programmatic and service development, and engage relevant stakeholders to align with and incorporate member/community voice.
• Support and navigation of complex clinical cases.
• Collaborate, form working relationships and serve as a liaison with MassHealth sister agencies integral to supporting LTSS members, specifically Department of Developmental Services (DDS), Department of Mental Health (DMH), Massachusetts Rehabilitation Commission (MRC) and Executive Office of Elder Affairs (EOEA).
• Support and participate in OCA medical management functions performed on behalf of MassHealth including but not limited to coverage, medical necessity guidelines, utilization management and program integrity.
• Collaborate with key LTSS stakeholders including Independent Living Centers (ILCs), ASAPs and contracted integrated care organizations to support their efforts to ensure an integrated LTSS care continuum that aims to improve utilization and outcomes, quality of care, social determinants of health and member experience for MassHealth LTSS members.
• Participate/lead in the development of policies, clinical standards, guidelines, criteria, and algorithms for use in MassHealth, ensuring adherence to all applicable federal and state laws and regulations, and review Managed Care Entities (MCEs) policies in collaboration with the MassHealth Office of Behavioral Health.
• Provide clinical support, expertise and leadership to OCA and MassHealth programs and clinical staff, including new care delivery and payment reform models, such as primary care payment reform, ACOs and Health Homes.
• Provide clinical consultation and guidance to the activities of LTSS program managers and on clinically complex LTSS cases.
• Provide updates and consult with OCA and MassHealth managers on new technologies, treatment methodologies and policies.
• Support Programs in reviewing specifications for all covered services.
• Participate in communications with MassHealth LTSS providers and vendors, and educate clinicians and others care partners on current MassHealth policy and programs.
• Participate in task forces, workgroups and other OCA, EOHHS or Office of Medicaid meetings as designated by the Director of OCA or his/her designee.
  Support the Director of OCA and Programs with the development and implementation of clinical, equity, quality and population health initiatives with focus on performance improvement projects.
• Participate in OCA activities to monitor, report upon, and make recommendations regarding equity, quality, clinical effectiveness and cost effectiveness of MassHealth LTSS programs, including quality assurance reviews of the integrated care management program and MCE care management initiatives, and provide recommendations to programs managers in designing and operationalizing program improvements.
• Participate in the establishment of departmental policies, procedures and objectives.
• Provide clinical leadership and mentoring for the OCA and MassHealth staff and work collaboratively with both clinical and non-clinical team members.
• Support and participate in our professional educational duty.
• Partner with other program leads (including Chief of Payment and Care Delivery Innovation( PCDI), Chief of Office of Behavioral Health and Chief of Provider and Pharmacy Programs) to integrate and align LTSS clinical policy and programs with overall MassHealth strategy
• 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 pediatrics, family medicine, or internal medicine with a minimum 3 years of experience in direct patient care, clinical experience with populations requiring LTSS support perferred
• Excellent oral and written communication skills
• Candidate must work onsite during normal business hours if deemed necessary by EHS
• Demonstrated ability to change entrenched clinical workflows

PREFERRED QUALIFICATIONS:

• Graduate degree in Public Health or Public Policy or other advanced degree in business or healthcare is desirable
• Experience in care of complex individuals and populations such as persons with Intellectual Disability (ID)/ Developmental Disability (DD), disability, geriatrics requiring home-based care, LTSS and/or HCBS is preferred.
• Experience in or familiarity care delivered with accountable care organizations (ACOs) or managed care organizations, i.e. PACE, SCO or Integrated Care Organizations (ICOs), community health centers (CHCs) or human service organizations, i.e. Aging Service Access Points (ASAP), Centers for Independent Living (CILs), etc.
• Experience in the application of state and federal Medicaid rules and regulations.
• Demonstrated ability to lead and manage in a matrixed organization and to execute and drive results
• Experience or familiarity with program implementation and/or project management.