Clinical Policy Advisor

The Health Connector’s Policy Department is seeking a physician or other professional with a medical, clinical, or pharmaceutical background to provide ongoing clinical and medical input and recommendations to inform the Health Connector’s health coverage programs and policy development. This individual will provide clinical input to the Policy and Plan Management teams, with particular focus on helping design clinically sound and innovative approaches to health coverage that prioritize population health and health equity. This individual will play a key role in shaping the clinical elements of health coverage products offered to hundreds of thousands of Massachusetts residents, including those enrolled in the Health Connector’s flagship affordability program for low to moderate income residents, ConnectorCare.

The Clinical Policy Advisor will contribute to the Health Connector’s plan design development and overall program and policy strategy in a variety of ways, which may include conducting clinical research, evaluating public health data, crafting policy recommendation presentations, evaluating and monitoring health insurance carriers’ implementation of and compliance with the Health Connector’s Value-based Insurance Design (VBID) initiatives, or developing other work product to investigate clinical and health care access policy topics. Aside from plan and product design more broadly, the Clinical Policy Advisor may also lead ongoing development and execution of efforts to ensure nondiscrimination in prescription drug formularies and benefit design, access to behavioral health, and trends in provider networks as they relate to emerging medical or pharmaceutical innovations. In addition to these primary projects, the Advisor may provide other research and advisory support to members of the policy team related to ongoing implementation of the federal and state health reform.

This position is designed to be a part-time position, working 1-2 days per week. The role’s schedule can be flexible to support the possibility that the desired candidate may also be in clinical practice

The Clinical Policy Advisor will be reporting to our Director of Plan Management and Carrier Relations.

Key Responsibilities:

• Conduct medical data and literature reviews to inform the Health Connector’s understanding of health care access topics
• Analyze qualitative and quantitative data from health insurers, member surveys, and other sources to identify trends in access to care and evaluate health insurers’ VBID program implementation
• Support development of policy guidance around low-cost access to drugs for chronic conditions
• Author clinical policy memos and recommendations and present findings to colleagues and leadership
• Organize and document reference and analytic resources
• Monitor population health and clinical dimensions of policy and coverage design in commercial insurance market and Medicaid program for environmental awareness
• Research established or emerging medical and pharmaceutical standards of care to understand best practices in access
• Attend regular meetings with the Policy and Plan Management teams
• Meet with other Health Connector staff and outside stakeholders to collect input for evaluating policy options and informing clinical and policy directions
• Other duties as assigned.

Experience & Qualifications:

• Medical, nursing, or pharmaceutical degree
• Experience in clinical practice and/or clinical research
• Position requires good standing in licensure for all licenses held regardless of current valid/expired status. Preference given to those currently holding an active license.
• Strong research, writing, oral communication, and analytical skills
• Experience analyzing and manipulating large data sets is a plus
• Experience working with health insurers is a plus
• Ability to work in a team setting
• Ability to take initiative and work independently on projects
• Ability to work under pressure with tight timelines
• Strong MS Office Suite skills, including but not limited to Word, Excel and PowerPoint

If interested: Send a cover letter and résumé to View email address on click.appcast.io.

Salary: $ 85.00 – 95.00/hour

Please note:

• Due to the requirement of 268A, please complete the Applicant Disclosure Form and return it with your application. Link:
• All Health Connector employees are required to provide satisfactory proof of eligibility to work in the United States
• This is a fully remote position.
• Employee may be requested to work an extended day and weekends to meet deadlines

About the Health Connector:

The Commonwealth Health Insurance Connector Authority (Massachusetts Health Connector) is an independent public authority serving as the Affordable Care Act (ACA)-compliant Marketplace for the Commonwealth. The organization is charged with providing subsidized and unsubsidized health insurance to individuals and small employers. The Health Connector also oversees policy development related to health care reform under both state and federal laws, as well as conducting public education and outreach about health care reform and coverage opportunities.

The Health Connector is an equal-opportunity employer that values diversity as a vital characteristic of its workforce. We consider qualified applicants without regard to race, color, religion, gender, sexual identity, gender identity, national origin, or disability.