Dir, Quality MassHealth PCDI
The Director of Quality for MassHealth Payment and Care Delivery Innovation (PCDI) supports the MassHealth PCDI team in the development and implementation of a quality program including a broad range of quality measures to ensure compliance and promote quality for all applicable stakeholders, including state, federal, Accountable Care Organizations (ACOs), Managed Care Organizations (MCOs) Community Partners (CPs) and members. The Director of Quality for Payment and Care Delivery Innovation reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA) or their designee. Works under the general direction of the MassHealth Chief of PCDI or their designee. Provides leadership in the development, implementation, and management of a quality program with robust reporting mechanisms and performance improvement related to a broad range of ACO, MCO, and CP-related quality activities. Serves as a thought leader on population health management and the integrated health models as relates to quality and performance improvement.Responsibilities
- In conjunction with MassHealth leadership, responsible for the development and ongoing implementation and evolution of robust reporting mechanisms to track, monitor and report ACO and MCO health quality-related performance (i.e., quality of care, access, and member experience measures).
- Design, implement and maintain the MassHealth PCDI quality program.
- Convene PCDI, MassHealth, and OCA teams as relevant to provide ongoing input on the PCDI quality program and to ensure alignment with MassHealth quality programs and strategy.
- Design, implement and maintain a robust strategy for measuring quality of care, utilization, and member experience for ACOs, MCOs and CPs.
- Monitor performance on quality of care, utilization, and member experience measures.
- Analyze quality data in service of program goals.
- Design and implement a quality reporting strategy for internal and external stakeholders in order to:
- Publicly report on quality performance in accordance with applicable regulatory and other requirements.
- Inform MassHealth program and policy development and implementation.
- Support performance management of PCDI accountable entities in collaboration with MassHealth contract management staff and teams.
- Lead the development and implementation of PCDI’s internal and external processes and practices for development of quality improvement goals and strategies and implementation of quality improvement action plans for PCDI accountable entities in collaboration with MassHealth clinical, contract management, and quality teams as well as with MassHealth providers.
- Lead communication with external stakeholders on PCDI quality program.
- Represent MassHealth on external stakeholder groups related to MassHealth and PCDI quality programs and lead development of related materials and communications.
- Partner with MassHealth Quality Team and MassHealth contracted vendors to comply with annual and other CMS quality reporting and improvement processes as required for MassHealth plans.
- Stay current on regulatory environment; serve as internal consultant to provide guidance and input on all matters concerning clinical compliance and regulation; implement, and sustain efficient methods of assuring consistent compliance with all relevant regulatory and quality monitoring requirements.
- Support case management and clinical review activities in collaboration with Office of Clinical Affairs staff, as needed;
- Perform retrospective clinical review of claims and member records as required to support program integrity, compliance, and quality assurance activities.
- Collaborate with staff to effectively meet departmental goals.
- Perform other duties as required.
REQUIRED EDUCATIONA graduate degree in public health or public policy or other advanced degree in business or healthcareREQUIRED WORK EXPERIENCE5 - 7 years or more of combined experience in clinical practice, health plan or health system quality management, practice management & redesign, and/or health services evaluationDemonstrated skills of developing, implementing, and evaluating quality and performance initiatives, including related to data collection and analysisDemonstrated expertise in local, regional, and/or national quality measurement areas including state/federal regulations related to healthcare quality Experience working with health care quality measures such as those employed by the Joint Commission, CMS, AHRQ, or health care systemsDemonstrated understanding of MassHealth innovations related to accountable care.Flexibility and ability to thrive in a fast-paced, dynamic environment. Excellent communication and presentation skills, both oral and written, to interact with leadership, staff, providers, and other stakeholders. Competency in computer skills: Microsoft Word, Excel, PowerPoint, and database softwarePREFERRED WORK EXPERIENCEDemonstrated understanding of the current MassHealth ACO and MCO programs.Experience developing quality measures for health care.
Working knowledge of complex federally funded innovative payment model projects and/or experience working in a Medicaid health system or provider group setting.Additional Information