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Dir, Quality MassHealth PCDI

Employer
University of Massachusetts Medical School
Location
One Ashburton Place

View more

Employment Type
Full Time
Institution Type
Four-Year Institution

Job Details

Overview

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.
Qualifications

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

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Organization

Realize Your Opportunities – A Career at UMASS Medical School

Inside Workings at UMASS Medical School

The University of Massachusetts Medical School (UMMS), the Commonwealth's only public medical school, is proud of our role in serving the people of Massachusetts. Although, its the inside workings of UMMS that makes the difference.

Mission and Culture

  • We’re serious about our mission and about our people. 
  • Real World Impact - Our people get excited about our mission of real-world impact in health sciences education, research and public service.
  • International Prominence and New Opportunities - As this institution has grown to national – and international – prominence, we’ve found new opportunities to train tomorrow’s physicians, nurses and scientists,  discover causes of and cures for disease and help improve the quality of health care.
  • Deep Commitment - With our clinical partner, UMass Memorial Health Care, and our other teaching affiliates, we share a deep commitment to national distinction in patient care.
  • Valued Partnerships – UMMS partners with Commonwealth Medicine, the health care consulting arm of UMMS. Also, UMMS partners with MassBiologics in scientific collaborations, technology management and creating partnerships for the development of products for the benefit of patients.  These valued partnerships help us to provide services and programs to help meet our needs at UMMS and the public.
  • Proud Contributors - People at UMMS enjoy the feeling of going to work every day knowing what they do is truly important and worthwhile.
  • Complementary and Inseparable - These varied parts of our mission and culture are complementary and inseparable.                 

Careers

UMMS, the state’s first and only public academic health sciences center, educates physicians, scientists and advanced practice nurses to heal, discover, teach and care, with compassion.  UMMS is a world-class institution with opportunities to match. 

Competitive Compensation – UMMS offers salaries that are competitive with Worcester-area employers. When combined with our generous benefits, perks, and paid time off, many job seekers are surprised to find a total rewards package that matches or exceeds their current situation.

Targeted Hiring Process – At UMMS, there are actually multiple hiring processes for different segments of our workforce.  In nearly all cases, UMMS hiring process is decentralized, with qualified candidates screened and referred to an academic officer or manager with hiring authority.

24/7 Access to Employment Opportunities – iCIMS is our online job search and application system.  iCIMS is available 24/7 to provide you with a convenient and up-to-date view of the available employment opportunities across our campuses. Updates are made daily and include all faculty and non-faculty position listings from every school and department within the UMMS. When you identify a position you are interested in and qualified for, apply online. New opportunities become available frequently so it pays to check back often!

Benefits

With outstanding benefits, competitive pay, extensive learning opportunities, and a stimulating and attractive work environment, UMMS may be exactly the employer you’ve been looking for.

• Superior Benefits - UMMS offers a wide range of benefits and perks that invite comparison with the best employers in the Worcester area – and with academic institutions anywhere. UMMS provides superior medical and dental coverage for you and your family, fully funded retirement plans, generous time off, a Tuition Assistance Plan – and much more.

• People Centered - UMMS is an employer, but it is also a community. Its comprehensive medical and dental benefits, retirement plans, and even paid holidays reflect an institution built around people, with a deep respect for their differences and needs.

• Commitment to Healthy Living - UMMS provides resources to help you balance work and life and encourages healthy living through great programs and discounts for fitness, physical activity, weight management, nutritional counseling and general wellness available through our health insurance plans.

• Breadth of Offerings - Above all, the breadth of UMMS offerings set the School apart and makes it an environment favored by all sorts of smart, career-savvy people.

Apply for a Job

As an equal opportunity and affirmative action employer, UMMS recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.

Online - To view all job opportunities and apply online, visit www.umassmed.edu/hr and click on the “Careers” tab.

Start Now and Realize Your Opportunities!

A History of Making Vital Improvements - UMASS Medical School Milestones

1962: Legislation establishes University of Massachusetts Medical School
1970: First medical students begin classes in Shaw Building
1974: First class graduates 16 MDs
1979: PhD program begins
1986: Graduate School of Nursing opens
1986: PhD program becomes Graduate School of Biomedical Sciences
1994: Graduate School of Nursing initiates PhD program
1998: UMass Clinical System and Memorial Health Care merge to form UMass Memorial Health Care
2001: Lazare Research Building opens
2002: Campus Modernization begins on the University Campus
2004: Graduate Entry Pathway Program established at the Graduate School of Nursing
2005: PhD Program in Clinical & Population Health Research established at the Graduate School of Biomedical Sciences
2005: Massachusetts Biologic Laboratories opens new manufacturing and filling facility in Mattapan
2006: Craig Mello, PhD, Blais University Chair in Molecular Medicine and Howard Hughes Medical Institute Investigator, is awarded the Medical School's first Nobel Prize. Dr. Mello shared the 2006 Nobel Prize in Physiology or Medicine with Andrew Fire, PhD, of Stanford University, for their discoveries related to RNA interference.
2007: Michael F. Collins, MD, is named chancellor and Terence R. Flotte, MD, is named dean of the School of Medicine.  
2009: Groundbreaking for the Albert Sherman Center, a 500,000-square-foot research and education facility slated for completion in 2012.
2010: Ambulatory Care Center opens
2012: The Albert Sherman Center, a 500,000-square-foot research and education facility, completed and opens

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