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MassHealth Chief Medical Officer (CMO) Job Number : 2025-47548
Category: Administrative Professional
Location : North Quincy, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Office Of Clinical Affairs - W401300
Job Type: Full-Time
Num. Openings : 1
Post Date : Jan. 12, 2025

The Chief Medical Officer (CMO) for MassHealth serves as the primary clinical leader, dedicated to ensuring that MassHealth members receive high-quality, equitable, and cost-effective healthcare services. This pivotal role involves overseeing the Office of Clinical Affairs (OCA) and providing strategic direction for clinical policy development, program management, and quality improvement initiatives. Reporting directly to the Deputy EVC of Operations, the CMO plays a key role in shaping healthcare delivery by advancing evidence-based practices, fostering innovation, and addressing health disparities to meet the needs of diverse and vulnerable populations. The CMO is part of the MassHealth Executive team and has a dual report to the Assistant Secretary for MassHealth Massachusetts Executive Office of Health and Human Services.

The Office of Clinical Affairs (OCA) acts as the clinical arm of Massachusetts Medicaid program, offering leadership in policy and coverage decisions, population health assessment, and the creation of quality and equity programs for value-based care. Additionally, OCA advises MassHealth on its programs and policies and represents the agency at both state and national levels.

Clinical and Strategic Leadership:

• Serve as the Chief Medical Officer (CMO) of MassHealth and Executive Leader of the Office of Clinical Affairs (OCA), overseeing all functions and staff to ensure alignment with organizational objectives.
• Provide clinical leadership and strategic guidance to develop and implement policies and programs that deliver high-quality, equitable, and cost-effective care to members.
• Act as the chief clinical advisor to the MassHealth Director, leadership teams, program managers, and other Executive Office of Health and Human Services (EOHHS) agencies, offering expertise on policy development, program execution, vendor management, and organizational goals.
• Oversee the evaluation of new technologies, medical procedures, and treatments, and guide the development of evidence-based clinical policies to improve healthcare delivery.
• Collaborate with internal and external stakeholders to integrate data systems for monitoring healthcare quality, addressing disparities, and assessing clinical and cost-effectiveness.
• Represent MassHealth in discussions with external stakeholders on clinical policy issues and share expertise in clinical management, quality improvement, and equity initiatives with MassHealth and EOHHS programs.

Operational Oversight:

• Direct the development, implementation, and management of OCA programs, including MassHealth quality programs, equity initiatives, and medical management strategies, ensuring seamless integration with broader MassHealth objectives.
• Lead the creation and maintenance of clinical standards, best practice guidelines, and policies aimed at enhancing healthcare quality for MassHealth members.
• Oversee critical program areas, including:
• Clinical Directors team.
• Equity, Quality and Population Health teams.
• Medical Management team.
• Prior Authorization and Utilization Management.
• Development of clinical components for plan and provider contracts.
• Collaborate with internal teams and external vendors to ensure adherence to federal and state regulations while maintaining high operational standards.

Compliance and Quality Management:

• Monitor compliance with all applicable regulations and provide clinical oversight of credentialing standards and processes for MassHealth providers.
• Develop strategies to meet quality improvement and equity objectives, using data-driven approaches to eliminate healthcare disparities and enhance outcomes for members.
• Implement integrated evaluation systems to measure program impact, monitor performance metrics, and drive improvements in care delivery and value-based care initiatives.
• Collaborate with ForHealth Consulting and UMass Chan Medical School on initiatives such as guideline development, provider education, and program evaluation to align with MassHealth's goals.
• Drive the achievement of clinical, operational, and fiscal objectives to ensure sustainable success and program efficiency.
• Oversee recruitment, development, and performance management of senior staff, fostering a high-performing and engaged team capable of meeting organizational goals.
• Monitor organizational outcomes, refine benchmarks, and implement improvement plans to maintain high standards of quality, equity, and operational performance.

Minimum Qualifications:

• A medical degree (MD or DO) with post-graduate training.
• Board certification and an active medical license.
• Current Massachusetts licensure or eligibility for a Massachusetts medical license without restriction.
• Advanced degree in public health, policy, or administration.
• 10+ years in clinical leadership roles, preferably in Medicaid or managed care.
• Experience with vulnerable populations and addressing social determinants of health.
• Proficient in data analytics, quality measures, and healthcare system development.

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