Director, Medicare Star Ratings & Revenue Management
Requisition #: 170350
Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
The Director of Medicare, Star Ratings is a highly visible, senior, strategic leadership role reporting to the Vice President, Medicare Advantage and is responsible for leading all aspects of the Medicare Star Ratings program. The Director is responsible for the following:
- Defining the Star Ratings strategy for the organization, including annual and long-term strategic plans for improvement
- Identifying, creating, leading, tracking, reporting, and managing all Star Ratings initiatives
- Achieving the Star Ratings performance goals of the health plan
- Building relationships with and leading cross-functional teams to drive Star Ratings initiatives and best practices by promoting innovation, strategy development, and implementation excellence
- Chairing and facilitating Executive-level committee meetings related to Stars, effectively communicating performance progress, new initiatives needed for higher performance, organizational barriers, and expectations of results
- Staying abreast of and keeping the organization apprised of existing and new Federal/State legislation impacting Star Ratings
- Developing and implementing strategies to engage, educate, and motivate providers to positively impact Star Ratings
- Effectively managing vendors and holding them accountable for high performance
- Driving positive culture transformation and corporate-wide awareness of Stars through education, communication, and employee engagement
Bachelor’s degree in health administration or a related field required. Advanced coursework and/or Master’s degree desirable.
Robust knowledge and strong experience with Medicare, and specific experience with Star Ratings, along with experience in compliance, health plan operations, and quality improvement activities
Detailed, “SME-level” knowledge of HEDIS, CAHPS, HOS, Part D, and Admin. measures
Strong knowledge and exposure to Federal and state regulations
Ability to lead organization wide-initiatives effectively
Ability to develop and lead high performing teams
Ability to define and promote a strong vision across a matrix organization with competing priorities
Excellent communication and interpersonal skills
Ability to lead all aspects of program/initiative management including strategic planning, needs analysis, content development, data analysis and reporting, vendor selection and management, and contract management
Ability to set priorities, meet objectives for complex projects involving multiple stakeholders, and execute according to plan
Ability to build effective relationships with cross-functional teams and external stakeholders
Ability to work across all levels of the organization, including work with individual contributors, executive and management audiences, physicians, and vendors
D. Required Licensure, Certification, Etc.:
E. Work Experience:
8 – 10 years of healthcare experience with relevant work in Medicare Advantage
Prefer 3 – 5 years of supervisory or leadership experience
F. Machines, Tools, Equipment:
PC, PC applications, and general office equipment.
A. Budget Responsibility:
Forecasts, plans and manages department-wide budget. 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.
C. Supervisory Responsibility:
Responsible for all aspects of management for Medicare Advantage operations. Assigns work and provide guidance and direction to others.
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, track trends and determine 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