Senior Clinical Director, Medical Management
- Employer
- University of Massachusetts Medical School
- Location
- One Ashburton Place
View more categoriesView less categories
- Employment Type
- Full Time
- Institution Type
- Four-Year Institution
Job Details
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.
Responsibilities•Leads development and implementation of Office of Clinical Affairs strategy for medical management to ensure appropriate, efficient, and high quality care delivery•Collects, analyzes and reports on medical management metrics to identify trends and recommend interventions•Accountable to improving efficiency, cost-effectiveness, and quality in OCA’s medical management programs, including through use of new technology as appropriate•Contributes to MassHealth’s cross-agency medical management strategy•Oversees Office of Clinical Affairs Medical Management Programs and functions•Oversees and contributes to OCA utilization management initiatives, including related to prior authorization, concurrent review, and retrospective review•Oversees and contributes to development and implementation of clinical coverage policies, including assessment of new and existing technologies.•Oversees and contributes to clinical reviews of providers•Reviews, analyzes, and responds to quality and safety data•Ensures high-performing medical management programs that adhere to all relevant regulatory and other requirements, including those set forth by CMS and other oversight entities•Advises and collaborates with the Chief Medical Officer (CMO) and Medical/Clinical Directors on strategic issues involving medical management programs•Serves as a lead interface for OCA medical management programs with other teams throughout the agency•Leads and/or supports external stakeholder engagements regarding coverage and medical management of services for MassHealth members•Manages clinical and non-clinical staff who are directly responsible for executing on OCA’s medical management initiatives•Ensures Medical Management staff maintain up-to-date knowledge, skills and abilities related to the administration of assigned responsibilities and functions•Oversees relevant contractors performing utilization management reviews on behalf of OCA/MassHealth•May engage in other clinical policies and program work within the MassHealth portfolio•Other duties as assigned
QualificationsLICENSURE/CERTIFICATION:•Current, unrestricted R.N., C.N.P, or P.A. license in Massachusetts throughout employment with OCAREQUIRED EDUCATION:Bachelor’s degree requiredREQUIRED QUALIFICATIONS:•At least 5 years experience in direct patient care•At least 5 years experience in a leadership position in utilization/medical management in a managed care organization/health plan•At least 5 years experience supervising clinical staff•Thorough knowledge of the principles and practices of medical management including utilization management•Excellent oral and written communication and presentation skills•Must work 1-2 days per week on site in Boston and/or Quincy during normal business hours
Additional InformationPREFERRED QUALIFICATIONS:
•Demonstrated commitment to serving Medicaid patients•Thorough knowledge of Medicaid and related regulations•Certification in case management and/or utilization management
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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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