Senior Clinical Director, Medical Management
Job Number : 2026-50362
Category: Management
Location : Boston, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Office Of Clinical Affairs - W401300
Job Type: Full-Time
Union Code: Non Union Position -W60- Non Unit Professional
Num. Openings : 1
Post Date : July 22, 2026
Work Location: Hybrid
Salary Minimum: USD $140,000.00/Yr.
Salary Maximum: USD $170,000.00/Yr.
The Senior Clinical Director for Medical Management will lead medical management strategy and operations for the MassHealth Office of Clinical Affairs to ensure the delivery of medically necessary, cost-effective, and high quality care for MassHealth members. Working closely with clinical and operational leaders within the Office of Clinical Affairs, this leader will oversee program initiatives related to utilization management (including prior authorizations), medical coverage policy, and care management.
•Leads development and implementation of Office of Clinical Affairs strategy for medical management to ensure appropriate, efficient, and high quality care delivery
•Collects, analyzes and reports on medical management metrics to identify trends and recommend interventions
•Accountable to improving efficiency, cost-effectiveness, and quality in OCAs medical management programs, including through use of new technology as appropriate
•Contributes to MassHealths cross-agency medical management strategy
•Oversees Office of Clinical Affairs Medical Management Programs and functions
•Oversees and contributes to OCA utilization management initiatives, including related to prior authorization, concurrent review, and retrospective review
•Oversees and contributes to development and implementation of clinical coverage policies, including assessment of new and existing technologies.
•Oversees and contributes to clinical reviews of providers
•Reviews, analyzes, and responds to quality and safety data
•Ensures high-performing medical management programs that adhere to all relevant regulatory and other requirements, including those set forth by CMS and other oversight entities
•Advises and collaborates with the Chief Medical Officer (CMO) and Medical/Clinical Directors on strategic issues involving medical management programs
•Serves as a lead interface for OCA medical management programs with other teams throughout the agency
•Leads and/or supports external stakeholder engagements regarding coverage and medical management of services for MassHealth members
•Manages clinical and non-clinical staff who are directly responsible for executing on OCAs medical management initiatives
•Ensures Medical Management staff maintain up-to-date knowledge, skills and abilities related to the administration of assigned responsibilities and functions
•Oversees relevant contractors performing utilization management reviews on behalf of OCA/MassHealth
•May engage in other clinical policies and program work within the MassHealth portfolio
•Other duties as assigned
LICENSURE/CERTIFICATION:
•Current, unrestricted R.N., C.N.P, or P.A. license in Massachusetts throughout employment with OCA
REQUIRED EDUCATION:
Bachelors degree required
REQUIRED QUALIFICATIONS:
•At least 5 years experience in direct patient care
•At least 5 years experience in a leadership position in utilization/medical management in a managed care organization/health plan
•At least 5 years experience supervising clinical staff
•Thorough knowledge of the principles and practices of medical management including utilization management
•Excellent oral and written communication and presentation skills
•Must work 1-2 days per week on site in Boston and/or Quincy during normal business hours
PREFERRED QUALIFICATIONS:
•Demonstrated commitment to serving Medicaid patients
•Thorough knowledge of Medicaid and related regulations
•Certification in case management and/or utilization management
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Posting Disclaimer:
This job posting outlines the primary responsibilities and qualifications for the role but is not intended to be an exhaustive list. Duties and expectations may evolve in response to the needs of the department and the broader institution.
In alignment with our commitment to pay transparency, the base salary range for this position is listed above (exclusive of benefits and retirement). At UMass Chan Medical School, final base salary offers are determined based on a combination of factors, including your skills, education, and relevant experience. We also consider internal equity to ensure fair and consistent compensation across our teams.
Please note that the range provided reflects the full base salary range for this position. Offers are typically made within the midrange to allow for future growth and development within the role.
In addition to base pay, UMass Chan offers a comprehensive Total Rewards package, which includes paid time off, medical, dental, and vision coverage, and participation in a 401(a)-retirement plan, with the option to contribute to a voluntary 403(b) plan.
UMass Chan welcomes all qualified applicants and complies with all state and federal anti-discrimination laws.
Salary : $140,000 - $170,000
