Requisition #: 332283
Location: Johns Hopkins Health Care, Hanover, MD 21076
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: March 8, 2021
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHC is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC has become a leader in provider-sponsored health plans and is poised for future growth.
Many organizations talk about transforming the future of healthcare, Johns Hopkins HealthCare is actually doing it. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for the members and communities we serve. If you are interested in improving how healthcare is delivered, join the JHHC team.
Under the direction of the AVP/ Sr. Director Quality Improvement, this execution-focused position of the Director, Medicaid Initiatives and Performance Improvement will support all Value Based Purchasing (VBP) and performance related activities for the Medicaid line of business, Priority Partners Managed Care organization (PPMCO), for JHHC.
Responsible for developing and driving the enterprise wide Medicaid VBP and performance improvement strategy and implementation through evaluating strategies, external capabilities and vendors to help drive best-in-industry Medicaid performance. Responsible for identifying innovative strategies to set market leading performance for PPMCO VBP measures. Must have deep industry connections to cutting edge strategies and external partners that can accelerate and maintain as an industry leader. Works collaboratively with PPMCO, enterprise leaders, and internal leadership to establish baseline capabilities and develop strategies for capability enhancement. Extensive market knowledge and research capability is necessary to best be able to evaluate opportunities. Collaborates and coordinates work with peers, other departments within matrix/shared service partners (including but not limited to Provider Relations, Pharmacy, Care Management, Utilization Management, Compliance, Appeals, Marketing and Communications, and IT).
This position will be responsible for the planning, development and execution of activities that support the Maryland Department of Health (MDH) or External Quality Review Organization (EQRO), Qlarant required deliverables such as audits, corrective actions, performance improvement plans (PIPs) as well as VBP strategies. In addition, this position will be responsible for executing performance management initiatives in accordance with VBP performance measures.
Task requirements for position:
Under the direction of the AVP/ Sr. Director Quality Improvement, this execution-focused position of the Director, Medicaid Initiatives and Performance Improvement supports all Value Based Purchasing (VBP) and performance improvement related activities for the Medicaid line of business, Priority Partners Managed Care organization (PPMCO), for JHHC.
This position is responsible for the planning, development, and execution of activities that support the Maryland Department of Health (MDH) or External Quality Review Organization (EQRO), Qlarant required deliverables such as audits, corrective actions, performance improvement plans (PIPs) as well as VBP strategies. The incumbent is responsible for supporting additional regulatory and accreditation requirements as well as other relevant needs for Medicaid line of business.
Bachelor’s degree in health administration or a related field required. Advanced coursework and/or Master’s degree preferred. Minimum 3-5 years of managed care experience, specifically in government programs, is required.
Managed Care Organizations (MCOs), VBP expertise, health systems operations, health care reimbursement models, quality improvement model
Must be results oriented individual with demonstrated implementation, collaboration and relationship building capabilities; high level of detail and organization; strong qualitative and quantitative analytical skills; Ability to communicate effectively, both orally and in writing; ability to prioritize and coordinate multiple tasks and work well under pressure; ability to develop policies, procedures, and workflows; strong research and data interpretation skills; good judgment; confidentiality, initiative and self-motivation
D. Required Licensure, Certification, Etc.:
E. Work Experience:
Minimum of 8- 10 years of healthcare experience with thorough knowledge of healthcare quality improvement, industry standard performance measures, healthcare reimbursement including valued based purchasing methodology and management, managed care, and tactics that result in member and provider engagement. Prefer 3-5 year supervisory experience.
F. Machines, Tools, Equipment:
PC, PC applications, and general office equipment. Thorough knowledge of Microsoft software applications
A. Budget Responsibility:
Ability to anticipate financial reporting, forecasting, and operational issues, assess implications, determine impact, develop, and implement appropriate action plan; Makes cost conscious decisions regarding purchase recommendations and spending. Considers cost effective alternatives.
B. Authority/Decision Making Level:
Independently makes decisions on all issues related to the department and vendor relationship. Organizes and prioritizes work to meet changing priorities. Makes decisions within the scope of authority and established guidelines. Able to manage data, resources, processes and tools to effectively translate business needs into effective and/or innovative solutions.
C. Supervisory Responsibility:
Ability to motivate staff as well as both internal and external customers; ability to diagnose problems and take the lead role in resolving them; ability to interact with a wide variety of health care professionals;
Work requires incumbent to be capable of accurately diagnosing performance gaps and thinking strategically to resolve underlying problems. Also resolving issues before health plan performance results are impacted.
Must be able to draw conclusions from data, report and track trends, and recommend solutions.
Works in a normal office environment where there are no physical discomforts due to temperature, noise, dust, etc.
Work frequently produces a high level of mental/visual strain due to extended use of PC
Work may require light lifting, stooping, or bending
Clipped from: https://jobs.hopkinsmedicine.org/job/director-medicaid-performance-improvement-leadership-johns-hopkins-health-care-332283-3e43d/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic