Senior Program Mgr, MassHealth Quality Programs OCA

Senior Program Mgr, Mass Health Quality Programs OCA Overview

Under the general direction of the Mass Health Chief Medical Officer/Director of OCA, or designee, the Senior Program Manager works directly with the Mass Health Quality Office and Mass Health Program leadership in the development and implementation of a cohesive approach to measuring and promoting quality, equity, and patient experience for Mass Health members.

ESSENTIAL FUNCTIONS

• Lead, in partnership with Mass Health program teams (including the Mass Health Office of Behavioral Health, the Mass Health Office of Long-Term Services and Supports, and the Office of Provider and Pharmacy Programs), strategy and design of quality programs including for behavioral health providers, Integrated Care Programs, and acute hospitals
• Lead, in partnership with Mass Health program teams, programmatic strategy and design including related to:
  • Selection of quality and health equity measures
  • Setting of performance targets
  • Establishing and testing performance assessment methodologies
  • Maintaining and updating contractual and regulatory documents to accurately reflect quality program design
• Together with Mass Health Quality Office leaders, contribute to the development and ongoing maintenance of the Mass Health Quality Strategy
• Regularly report to OCA leadership and staff (and other entities, at OCA leadership direction) on the status of Mass Health quality and health equity measurement programs and progress towards quality and health equity priorities.

• Lead, in partnership with Mass Health program teams, implementation of Mass Health quality and health equity measurement programs including for behavioral health providers, long-term services and supports including those delivered through Integrated Care Programs, and acute hospitals
• Monitor and analyze quality and health equity measurement program performance
• Lead performance remediation processes, as applicable
• Monitor, analyze, and report on quality and health equity measure performance
• Lead and/or support program teams in developing and implementing quality and health equity performance management activities
• Manage necessary quality analytics resources to support Mass Health quality and health equity program functions, including by coordinating and overseeing inputs from OCA and Mass Health data and analytics staff

• Lead stakeholder engagement and education activities with external stakeholders (providers, health system representatives, federal authorities including CMS) through activities such as leading regular office hours, maintaining stakeholder requests, and through other venues as assigned
• Manage negotiations with CMS, as needed, to support continued authority for quality and health equity measurement programs
• Lead and/or support relevant Mass Health program advisory groups, including by preparing materials, managing activities, and being accountable for necessary follow-up activities
• Engage with contracted vendors, as appropriate, on Mass Health quality and health equity measurement program-specific deliverables

• Serve as a subject matter expert for Mass Health quality and health equity measurement programs
• Contribute to design and implementation of cross-cutting quality initiatives that impact multiple programs within Mass Health, including related to health equity and member experience

Hire, advise and directly supervise and evaluate performance of other staff. Provide functional supervision of other specific project/program staff as needed.

Review and monitor compliance with the federal and state regulations.

Perform other duties as required.

• Master's Level Degree in Health Care or Business Administration, Public Health, or a quality related health care field.

• 5 - 7 years of experience leading health care quality measurement and performance programs
• Experience with acute hospital quality measurement
• Experience with behavioral health quality measurement and/or long-term-services or supports quality measurement
• Experience in a recent management/supervisory role
• Excellent communication and presentation skills, both oral and written, to interact with leadership, staff, providers and other stakeholders.

• Experience with quality measurement in ambulatory and inpatient settings
• Experience with Medicaid quality measurement programs
• Experience with health equity measurement
• Experience with quality measure development
• Quality analytics experience, including use of Medicaid claims data
• Flexibility and ability to thrive in a fast-paced, dynamic environment.

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