Sr. Medical Director, MassHealth

Overview Under the general direction of the Director of the Office of Clinical Affairs (OCA)/Chief Medical Officer or designee, the Sr. Medical Director MassHealth will serve as a clinical expert resource for OCA and MassHealth programs and MassHealth providers. The Senior Medical Director will lead key areas related to clinical policy and programs; population health, quality and health equity; stakeholder engagement; medical management; and management and staff development to improve health, quality, equity, efficiency, and appropriateness of care for MassHealth members. Responsibilities Clinical Strategy, Policy, and Programs * Serves as a senior clinical leader for OCA and MassHealth programs * Leads development and implementation of clinical policies and programs for MassHealth * Leads development and implementation of innovative approaches for improving the quality, efficiency, and appropriateness of care delivered to MassHealth members * Closely collaborates with one or more program teams at MassHealth to meet their clinical policy and programs needs * Provides clinical support and expertise to OCA and EOHHS programs and clinical staff to inform MassHealth policies and programs * Provide clinical expertise and engagement to support prompt and responsive resolution to clinical case escalations * Participate in OCA activities to monitor, report upon, and make recommendations regarding the quality, clinical effectiveness, and cost-effectiveness of MassHealth medical services and programs. * Holds accountability for designing and implementing effective MassHealth clinical policies and programs that meet the needs of MassHealth * Ensures clinical policies and programs are compliant with relevant state and federal requirements Population Health, Quality, and Health Equity Policy and Programs * Provide leadership in the development and implementation of a cohesive approach to promoting high quality, equitable, efficient, and appropriate clinical care for MassHealth members * Serves as a clinical subject matter expert informing MassHealth's value-based care programming, including related to quality measurement and clinical performance * Oversee clinical quality improvement initiatives for MassHealth's programs * Support development, implementation, and evaluation of clinical performance measurement programs for MassHealth programs * Develop and implement strategies to improve clinical and population health outcomes for MassHealth members Stakeholder Engagement * Collaborate with and serve as a clinical liaison for MassHealth plans and providers to support their efforts to improve high quality, equitable, efficient, and appropriate clinical care for MassHealth members. * Communicate and coordinate with contracted plans and providers and serve, when needed, as the clinical liaison between MassHealth and plans and providers serving MassHealth members. * Lead internally- and externally-facing OCA, MassHealth and/or EOHHS meetings * Build and maintain effective working relationships with cross-functional leaders and teams within MassHealth and EOHHS to identify, explore, present and implement clinical strategy, policies and programs * Establish and maintain collaborative relationships with external stakeholders, including plans and providers as well as community organizations and other stakeholders * Establish and maintain collaborative, productive relationships with federal partners and authorities Medical Management * Oversee components of MassHealth medical management strategy, programs and/or policies * Participate in medical management activities, such as prior authorization reviews and clinical policy development Leadership * Provide clinical leadership and mentoring for OCA and MassHealth staff and work collaboratively with both clinical and non-clinical team members. * Supervise approximately 3-5 clinical and/or non-clinical staff * Support the experience of trainees and other rotators at MassHealth, including clinical trainees * Perform other similar and related duties as required or as directed Qualifications * Medical Doctor or Doctor of Osteopathy.• Actively licensed to practice medicine without restriction in Massachusetts throughout employment with OCA.• Board-certified in an ABMS recognized specialty; may be Board-eligible upon employment but must be Board-certified within one year of hire.• At least 7 years of policy/population health/public health experience; relevant experience before or during medical training may be taken into consideration. * Excellent oral and written communication and presentation skills • Must work 2 days per week on site in Boston and/or Quincy during normal business hours • Proven ability to develop and successfully implement strategic initiatives. Additional Information Preferred Qualifications: * Experience delivering medical care in clinical settings across the continuum of care. * Demonstrated commitment to serving MassHealth and/or other Medicaid populations

Created: 2026-04-15