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State of Massachusetts Clinical Lead in Boston, Massachusetts

*Description* The MassHealth Office of Long Term (Care) Services and Supports (OLTSS) is responsible for managing a robust system of supports for members of all ages who need services to enable them to live with independence and dignity in their daily lives, participate in their communities, and increase their overall quality of life. These services and supports may be provided in the home; in residential, day, and other community-based settings; or in certain facility-based settings, such as nursing homes and chronic disease rehab hospitals. Additionally, OLTSS manages fully capitated integrated care plans primarily for dually eligible individuals (i.e. Medicare and Medicaid): Senior Care Options (SCO), the One Care Program, and the Program of All-Inclusive Care for the Elderly (PACE). OLTSS also oversees 10 home- and community-based (HCBS) Medicaid waiver programs that provide specialized services and supports to especially vulnerable OLTSS populations. OLTSS is responsible for ensuring that services provided in any setting and all delivery systems are member-focused, accessible, of the highest quality, and delivered in a cost-effective manner. The Clinical Lead will manage a team of nurses (also known as “Field Nurses” or “Field Nurse Reviewers”) who perform clinical audits of all OLTSS programs, with a primary focus on Institutional program providers (Nursing Facilities and Chronic Disease and Rehabilitation Hospitals), and provide clinical expertise to the Institutional Program, OLTSS, and MassHealth generally. _Duties and Responsibilities (these duties are a general summary and not all inclusive):_ The Clinical Lead will be responsible for: 1. Monitoring audits of nursing facility (NF) resident assessments (e.g., MMQ, MDS), conducted by the state vendor (“LTSS TPA”), coordinating Field Nurse reviews of these audits, and performing their own on-site audits of resident assessments (as needed): 1. Devising and maintaining a sampling plan and schedule for Field Nurse reviews based on LTSS TPA audit schedule 2. Drafting audit tools, standard operation procedures (SOPs), and other project documentation 3. Tracking and summarizing audits performed by the LTSS TPA and audit reviews performed by Field Nurses 4. Presenting results to program staff and management verbally and in a variety of written formats 5. Coordinating feedback to LTSS TPA, including trainings, presentations, coaching, etc. 6. Evaluating LTSS TPA performance, methods, and staffing 7. Performing their on-site audits (as needed) 8. Accompanying LTSS TPA staff during on-site audits (as needed) to assist with workload and for purposes of supervision 2. Coordinating other audits and reviews of Institutional providers and contractors (as needed), including but not limited to: 1. Assessing need and gathering requirements for audit/review work from Institutional Program staff 2. Per identified needs and requirements, leading Field Nurse Reviewers in a variety of on-site audit/review activities, including but not limited to site audits; member home visits; surveys; provider staff interviews; desk audits / reviews related to special NF populations, individuals with SMI or ventilator-dependent NF residents; activities related to nursing facility closures, etc. 3. Using clinical expertise to assist program staff in clinical aspects of managing OLTSS programs, including but not limited to: 1. Providing clinical assistance and input on draft regulations, policy memos, and reports and other materials, such as the Uniform Care Assessment (UCA) 2. Drafting/reviewing medical necessity criteria 3. Representing OLTSS on clinical matters in meetings with providers, clinicians, and contractors and advising on stakeholder communication strategies 4. Assisting in development of long-term strategy and policy development for institutional programs, such as clinical performance measures, quality measurement, alternative patient classification systems, identification of best practices 5. Responding to program staff and providers on clinical cases, such as hard-to-place MassHealth members, constituent complaints, provider questions, critical incident reports, and the like 4. Providing back-up assistance to other OLTSS teams (e.g., Community FFS, Home-based FSS, and Integrated Care Programs), when necessary, during surges in their workload. 5. Recruitment, development, and training of staff and supervising daily activities of field nurses. 6. Other ad-hoc support, such as clinical and administrative tasks to support OLTSS programs. _Preferred Qualifications:_ * Minimum 3 years of direct experience managing a team of experienced registered nurses * Up-to-date certification to conduct MDS assessments in nursing facilities * Experience in: o Conducting MDS and MMQ assessments o Using Electronic Medical Records o Medical records reviews o Training staff on clinical guidelines and assisting program staff with creating clinical assessment tool o Writing clinical regulations for a state agency and/or standard operating procedures, protocols, etc. for a private entity o Word, Excel, and Outlook * Knowledge of: o MDS-based payments o PDPM o Wide range of nursing principles and standards o Geriatrics or people with disabilities, or both o Long term care regulations, standards and practices and guidelines governing agency operation and assigned unit function * Ability to: o Maintain accurate records o Follow written and oral instructions o Communicate both verbally and in writing information in a manner which is precise and understandable o Maintain harmonious working relationships with others and mentor staff o Do other ad-hoc tasks to support OLTSS _Special Requirements:_ Licensed Registered Nurse _TO APPLY:_ Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days. _About MASSHEALTH:_ The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life. For more information about our agency and programs please visit: _Pre-Hire Process:_ A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit and click on "Information for Job Applicants". Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines. Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website. If you require assistance with the application/interview process and would like to request an ADA accommodation, please click on the link and complete the Reasonable Accommodation Online Request Form For questions, please the contact the Office of Human Resources at 1-800-510-4122 and select option #2. First consideration will be given to those applicants that apply within the first 14 days. MINIMUM ENTRANCE REQUIREMENTS: Applicants must have at least (A) three years of full-time, or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic or medical facility and (B) of which at least two years must have been in a supervisory, administrative, or managerial capacity, or (C) any equivalent combination of the required experience and the substitutions below. Substitutions: I. A Graduate degree with a major in Nursing may be substituted for a maximum of one year of the required (A) experience.* No substitutions will be allowed for the required (B) experience. Education toward such a degree will be prorated on the basis of the proportion of the requirements actually completed. SPECIAL REQUIREMENTS FOR ALL LEVELS IN SERIES: Current and valid registration as a professional nurse under the Massachusetts Board of Registration in Nursing . Recent graduates from an approved school of nursing must have applied for the first available registered nurse examination. Special Requirements: Based on assignment, possession of a current and valid Massachusetts Motor Vehicle Operator's license may be required. _Comprehensive Benefits_ When you embark on a career with the Commonwealth, you are offered an outstanding suite of employee benefits that add to the overall value of your compensation package. We take pride in providing a work experience that supports you, your loved ones, and your future. Want the specifics? Explore our Employee Benefits and Rewards! *Executive Order #595:As a condition of employment, successful applicants will be required to have received COVID-19 vaccination or an approved exemption as of their start date. Details relating to demonstrating compliance with this requirement will be provided to applicants selected for employment. Applicants who receive an offer of employment who can provide documentation that the vaccine is medically contraindicated or who object to vaccination due to a sincerely held religious belief may make a request for exemption. An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply. The Commonwealth is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, sex, gender identity or expression, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. Research suggests that qualified women, Black, Indigenous, and Persons of Color (BIPOC) may self-select out of opportunities if they don't meet 100% of the job requirements. We encourage individuals who believe they have the skills necessary to thrive to apply for this role. Job: Medical Services* *Organization: Exec Office Of Health and Human Services *Title: *Clinical Lead Location: Massachusetts-Boston-1 Ashburton Place Requisition ID: 22000CTO