GENERAL SUMMARY OF POSITION:

The Associate Medical Director (AMD), under the direction of the Director of the Office of Clinical Affairs (OCA) or his/her designee, is responsible for providing clinical expertise to OCA and EOHHS program staff. The AMD will participate in the development and evaluation of clinical standards and guidelines for MassHealth medical services, conduct prior authorization reviews and serve as a clinical resource for OCA and EOHHS programs as well as MassHealth providers.

MAJOR RESPONSIBILITIES:

• Provide clinical support and expertise to OCA programs and clinical staff.
• Participate/lead in the development of policies, clinical standards, guidelines, criteria, and algorithms for use in MassHealth medical services, ensuring adherence to all applicable federal and state laws and regulations.
• Provide clinical support and expertise to the prior authorization process, and document approval and denial determinations around coverage of medical services.
• Assist the Director of OCA or his/her designee in the identification and implementation of opportunities for improving the physician review process (including research and documentation of prior authorization determinations).
• Provide clinical leadership to the activities of medical program managers.
• Provide updates and consult with OCA and MassHealth managers on new technologies, treatment methodologies and policies.
• Participate in communications with MassHealth medical providers, conduct peer-to-peer discussions, as applicable, and educate physicians and others on current policy and prior authorization issues.
• Participate in or lead Advisory Board meetings and other OCA, EOHHS and Office of Medicaid meetings as designated by OCA Director or his/her designee.
• Assist the Director of OCA with the development and implementation of clinical, quality and analytics initiatives
• Participate in OCA activities to monitor, report upon, and make recommendations regarding quality, clinical effectiveness and cost effectiveness of MassHealth medical services and programs.
• Provide clinical leadership and mentoring for the OCA and MassHealth staff and work collaboratively with both clinical and non-clinical team members.
• Perform other similar and related duties as required or as directed.

REQUIRED QUALIFICATIONS:

• Medical Doctor or Doctor of Osteopathy
• Actively licensed to practice medicine without restriction in Massachusetts throughout employment with OCA
• Board certified in area of specialty and minimum 5 years of experience in direct patient care
• Must work onsite during normal business hours

PREFERRED QUALIFICATIONS:

• Experience providing direct care to disabled and/or elderly populations or working in or with managed care organizations (e.g. PACE, SCO, or Integrated Care Organizations (ICOs)) serving these populations, including familiarity with long-term and other community services that support them
• A graduate degree in Public Health or Public Policy or other advanced degree in business or healthcare is desirable.
• Experience in the application of state and federal Medicaid rules and regulations