Deputy Chief Medical Officer MassHealth

Reporting to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA), the Deputy Chief Medical Officer works collaboratively across a matrixed organization to provide clinical leadership, oversight, and expertise to OCA and MassHealth. The Deputy Chief Medical Officer initiates, leads, coordinates and implements clinical and population health strategy and collaborates with program staff in the design, implementation, and evaluation of clinical programs and initiatives to support delivery of high quality, high value care. The Deputy Chief Medical Officer oversees MassHealth Quality and Equity Programs, and serves as a member of the OCA, MassHealth and Commonwealth Medicine leadership teams, assuming the administrative responsibilities of the MassHealth Chief Medical Officer/Director of OCA upon his/her request.

* Leads and oversees MassHealth Quality and Equity Programs and Teams.
* Participate with the MassHealth Chief Medical Officer/Director of OCA and other OCA clinical leaders in strategic planning to develop and implement clinical and population health policy and strategy.
* Lead and support development and implementation of innovative approaches to provide high quality, high value care.
* Collaborate with program managers in the design, development, implementation, and evaluation of clinical and population health programs and initiatives, including related to quality, equity, population health, pharmacy, behavioral health, and medical management.
* Provide clinical support and expertise to cost savings initiatives, credentialing, appeals, care management/disease management activities, fraud/waste/abuse efforts, and other clinical initiatives as required.
* Participate in/lead the development of policies, clinical standards, guidelines, criteria, and algorithms for use in MassHealth medical services, ensuring adherence to all applicable federal and state laws and regulations.
* Provide clinical leadership to OCA programs and clinical staff, including training and monitoring clinical staff performance on case development and utilization management decision-making.
* Analyze and interpret medical trends, utilization data and process measures to ensure that processes are in place to meet or exceed organizational goals.
* Participate in OCA activities to monitor and report upon quality, clinical effectiveness, cost effectiveness and ROI of MassHealth internal and/or vended program interventions.
* In collaboration with the MassHealth Chief Medical Officer and/or his/her designee, assist in the identification and implementation of opportunities for improving the physician review process.
* Participate in communications with MassHealth medical providers, conduct peer-to-peer discussions, as applicable, and educate physicians and others on current policy and prior authorization issues.
* Provide clinical leadership in clinical research and analysis initiatives within OCA.
* Comprehensively understand and apply local, state and national trends in health care delivery and managed care to positively influence MassHealth policy.
* Assist in the development of system-wide data and studies of clinical standards of care to identify best practices associated with improved health outcomes and to ensure that efficient and effective programs and approaches are developed consistent with optimal clinical practice.
* Represent the MassHealth Chief Medical Officer/Director of OCA at OCA, MassHealth, ForHealth Consulting and external meetings as requested by the MassHealth Chief Medical Officer/Director of OCA.
* Supervise, train, coach, mentor, evaluate and ensure the professional development of the OCA and MassHealth physician staff and other OCA staff as assigned.
* Is accountable for assigned staff's attendance and coverage, productivity, quality and timeliness of work product, and other supervisory duties as required.
* Work collaboratively with both clinical and non-clinical team members.
* Perform other similar and related duties as required or as directed.

Required Education

Medical Doctor or Doctor of Osteopathy and actively licensed to practice medicine without restriction in Massachusetts throughout his/her employment with OCA

Board certified in the area of specialty with a minimum of 5 years of experience in direct patient care

Required Work Experience

3 to 5 years of experience in a recent management/supervisory role, including supervising both clinical and non-clinical staff

Demonstrated ability to build relationships and lead multidisciplinary teams in the attainment of quantifiable goals

Experience designing and implementing innovative clinical programs

Experience developing clinical policy

Excellent written and verbal communication skills

Proficient in the use of data analytics to identify, direct and improve the quality and efficiency of care delivered to MassHealth members

Preferred Education

An MPH, MMM, MBA, other advanced degree in business or healthcare management, or CPE is desirable

Preferred Work Experience

Experience working with populations served by Medicaid
Experience providing direct care to disabled and/or elderly populations or working in or with managed care organizations serving these populations
Experience in the application of state and federal Medicaid rules and regulations
Utilization management experience is desirable