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Associate Medical Director, Pediatrics - Hybrid
Job Number: 2023-44789
Category: Healthcare
Location: Boston, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Office Of Clinical Affairs - W401300
Job Type: Full-Time
Salary Grade: 50
Union Code: Non Union Position -W60- Non Unit Professional
Num. Openings: 1
Post Date: Jan. 19, 2024
Under the general direction of the Director of the Office of Clinical Affairs (OCA)/Chief Medical Officer or designee, the Associate Medical Director (AMD) will serve as a clinical expert resource for OCA and MassHealth programs and MassHealth providers. The Associate Medical Director will serve as a clinical expert and leader in developing and implementing programs to improve quality, equity, efficiency, and appropriateness of care delivered to MassHealth members.
Clinical Strategy, Policy and Programs
Serve as clinical subject matter expert for MassHealth clinical policy and programs, including those pertaining to children and youth.
- Lead/advise, in partnership with MassHealth program teams, strategy and design of clinical policy for children and youth, including those with medical, behavioral, and social complexity as well as disability.
- Contribute to monitoring, reporting on, and making recommendations to align MassHealth clinical policy and programs with cost, quality, patient experience, provider experience, and equity aims.
Engagement
Build and maintain effective working relationships with leaders and teams across MassHealth to optimize clinical policy and programs, including by:
- Serving as a key clinical liaison and advisor to MassHealth's Office of Provider and Member Programs (OPMP) and MassHealth's Parent, Child, and Family Team (PCF Team).
- Engaging with key internal and external stakeholders, including serving as a clinical liaison for MassHealth clinical (including pediatric) providers, maintaining open channels of communication, educating on MassHealth policies and programs.
- Partnering with other EOHHS agencies and programs to improve care for MassHealth members, including children and youth.
- Engaging with external organizations serving MassHealth members.
Population Health, Quality, and Health Equity Policy and Programs
Provide clinical leadership and support for the development and implementation of MassHealth population health, quality, and health equity programming; including pertaining to MassHealth children and youth. Responsibilities include:
- Contributing to population health, quality, and health equity policy development, including for agency priority areas (such as care for LGBTQI+ and justice-involved members).
- Advising on the design and development of quality and equity measurement and value-based care programs for MassHealth providers, including for children and youth.
- Advising on population health, quality, and equity performance management for MassHealth providers, including pertaining to MassHealth children and youth.
- Supporting population health management, including for MassHealth children and youth.
Medical Management
Contribute to MassHealth medical management strategy and policy, including pertaining to children and youth:
- Participate/lead in the development of policies, clinical standards, guidelines, criteria, and algorithms for use in MassHealth medical/clinical services.
- Provide updates and consult with OCA and MassHealth managers on new technologies, treatment methodologies, and policies.
- Participate and support OCA in medical management activities including but not limited to Prior Authorization (PA), Chronic Disease Rehabilitation Hospital (CDRH) utilization management, Disability Eligibility determination audits (DES), and Program Integrity reviews.
Leadership
Contribute to hiring, advising, and evaluating performance of other staff as needed. Provide functional/indirect supervision of specific project/program staff as needed. Provide leadership, teaching, and mentorship to visiting trainees including lecturing on areas of expertise. Perform other similar and related duties as required.
REQUIRED EDUCATION
Medical Doctor or Doctor of Osteopathy degree.
REQUIRED WORK EXPERIENCE
Actively licensed to practice medicine without restriction in Massachusetts throughout his/her employment with OCA. Board certified in pediatrics or family medicine with a minimum of 3 years of experience in direct patient care of children. Excellent oral and written communication and presentation skills including proficiency with Microsoft Excel and PowerPoint. Must work 1-2 days onsite in Boston and/or Quincy during normal business hours (this position is currently Hybrid). Proven ability to develop and successfully implement strategic initiatives.
PREFERRED WORK EXPERIENCE
Expertise in general pediatrics as well as care of complex pediatric populations (such as populations with medical complexity, disability, requiring long-term services and supports, etc). Experience with and expertise in health policy, including related to evidence review and policy development. Experience with quality measurement, including related to pediatric populations. Experience with MassHealth or another Medicaid and/or Children's Health Insurance Program. Experience with care delivery in community health centers including Federally Qualified Health Centers. Graduate degree or equivalent experience in Public Health, Public Policy, or other healthcare-related discipline. Experience with care delivery in accountable care organization and/or managed care organization construct.
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