Quality & Compliance OBH Manager

Employer
University of Massachusetts Medical School
Location
One Ashburton Place

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Administrative Jobs
Institutional & Business Affairs, Assessment, Accreditation & Compliance

Job Details

Overview

The Quality and Compliance OBH Manager supports the MassHealth Office of Behavioral Health (OBH) in the monitoring of behavioral health quality measures to ensure compliance and promote quality for all applicable stakeholders, including state, federal, ACO contracts and member experience. The position will serve an active role in the development of robust reporting mechanisms and performance improvement related to behavioral health quality, including conducting behavioral health provider audits. The Quality and Compliance OBH Manager reports to the MassHealth Chief Medical Officer/Director of the Office of Clinical Affairs (OCA), but will work under the general direction of the Deputy Director of Quality and Compliance and the Clinical Director of the Office of Behavioral Health or designee.

Responsibilities

• In conjunction with MassHealth leadership, responsible for the development and ongoing implementation and evolution of robust reporting mechanisms to track, monitor and report behavioral health quality-related performance (i.e., quality of care, access and member experience measures). • Maintain quality oversight of MassHealth members receiving behavioral health care, including, but not limited to: 1) the Primary Care Clinician Plan—including the specialty behavioral health plan, the Massachusetts Behavioral health Partnership (MBHP); 2) MassHealth’s contracted Managed care entities (MCEs); 3) the integrated Medicaid and Medicare managed care plans, such as One Care, Senior Care Options & the Program of All-inclusive Care (PACE); 4) and members enrolled in Accountable Care Organization (ACO) models.• Knowledge of clinical best practices for the delivery of behavioral health care; serve as an internal and external resource on such practices and use such awareness to inform monitoring compliance with clinical best practices in MassHealth behavioral health providers.• Develop and implement the most efficient methods of assuring behavioral health provider compliance with all current regulatory and quality monitoring requirements, including adverse incident reporting and quality measurement.• Identify necessary resources to perform BH Quality Oversight, including organizing and coordinating resources from MassHealth; monitor work progress, including data analysis and reports.• Comfort with conducting site audits, at times in collaboration with other EOHHS departments, which include evaluation of behavioral health clinical care delivery against clinical best practice standards, MassHealth regulation, clinical specification and/or additional standards.• Support OBH team in new program and policy development based on identified quality improvement opportunities.• Support case management and clinical review activities in collaboration with the 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 EDUCATION: Bachelor’s Degree or equivalent.

 

REQUIRED QUALIFICATIONS:

• 3 – 5 years of combined experience in clinical practice, health plan quality management, practice management & redesign, and/or health services evaluation

• Clinical background – Licensed mental health clinician (LICSW, LCSW, LMHC, LMFT) with demonstrated understanding of behavioral health levels of care, inclusive of Mental Health and Substance Use treatment services.• Demonstrated skills of developing, implementing and evaluating quality and compliance with applicable regulations and practices in a behavioral health treatment setting• Working knowledge of complex federally funded innovative payment model projects and/or experience working in a Medicaid health system or provider group setting.• Ability to research and analyze state/federal regulations related to healthcare quality Familiarity with EOHHS mental health and substance use regulations, ED Boarding improvement initiatives, hospital quality, and/or behavioral health integration in primary care a plus.• Ability to perform clinical case consultation to assist care management teams on appropriate level and type of behavioral health care for members who may be experiencing difficulties in accessing 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.

 

PREFERRED EDUCATION: Master's Degree or equivalent.

 

#LI-BG1

 

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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