Senior Clinical Director, Medical Management

The Senior Clinical Director for Medical Management will lead medical management strategy and operations for the MassHealth Office of Clinical Affairs to ensure the delivery of medically necessary, cost-effective, and high quality care for MassHealth members. Working closely with clinical and operational leaders within the Office of Clinical Affairs, this leader will oversee program initiatives related to utilization management (including prior authorizations), medical coverage policy, and care management. Leads development and implementation of Office of Clinical Affairs strategy for medical management to ensure appropriate, efficient, and high quality care deliveryCollects, analyzes and reports on medical management metrics to identify trends and recommend interventionsAccountable to improving efficiency, cost-effectiveness, and quality in OCAs medical management programs, including through use of new technology as appropriateContributes to MassHealths cross-agency medical management strategyOversees Office of Clinical Affairs Medical Management Programs and functionsOversees and contributes to OCA utilization management initiatives, including related to prior authorization, concurrent review, and retrospective reviewOversees and contributes to development and implementation of clinical coverage policies, including assessment of new and existing technologies.Oversees and contributes to clinical reviews of providersReviews, analyzes, and responds to quality and safety dataEnsures high-performing medical management programs that adhere to all relevant regulatory and other requirements, including those set forth by CMS and other oversight entitiesAdvises and collaborates with the Chief Medical Officer (CMO) and Medical/Clinical Directors on strategic issues involving medical management programsServes as a lead interface for OCA medical management programs with other teams throughout the agencyLeads and/or supports external stakeholder engagements regarding coverage and medical management of services for MassHealth membersManages clinical and non-clinical staff who are directly responsible for executing on OCAs medical management initiativesEnsures Medical Management staff maintain up-to-date knowledge, skills and abilities related to the administration of assigned responsibilities and functionsOversees relevant contractors performing utilization management reviews on behalf of OCA/MassHealthMay engage in other clinical policies and program work within the MassHealth portfolioOther duties as assigned Licensure/Certification Current, unrestricted R.N., C.N.P, or P.A. license in Massachusetts throughout employment with OCA Required Education Bachelors degree required Required Qualifications At least 5 years experience in direct patient careAt least 5 years experience in a leadership position in utilization/medical management in a managed care organization/health planAt least 5 years experience supervising clinical staffThorough knowledge of the principles and practices of medical management including utilization managementExcellent oral and written communication and presentation skillsMust work 1-2 days per week on site in Boston and/or Quincy during normal business hours Preferred Qualifications Demonstrated commitment to serving Medicaid patientsThorough knowledge of Medicaid and related regulationsCertification in case management and/or utilization management The University of Massachusetts Chan Medical School welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.