Senior Director, Product Development and Program Analytics

Johns Hopkins Healthcare   •  

Glen Burnie, MD

Industry: Healthcare

  •  

11 - 15 years

Posted 38 days ago

Requisition #: 182278
Location: Johns Hopkins Health Care, Glen Burnie, MD
Category: Leadership
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: March 3, 2019

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.

Responsible for strategic product development, positioning and performance of all activities that drive Medicare programs financial and operational goals and objectives. Ensures that all program activities are tracked and adjusted as necessary to deliver ontargets. The incumbent executes overall program strategy with our internal and external partners. The position will have direct responsibility for driving rate setting and market positioning of the products. This position must develop benefits and drive value statement incorporated in marketing strategies for the product lines in order to achieve profitability consistent with the corporate objectives, incorporating the financial performance opportunities including Stars, risk adjusted revenue, and cost containment. Responsible for coordinating with Centers for Medicare and Medicaid Services (CMS) regarding requirements such as reporting, bid filing and benefit requirements. Ensures the efficacy of all internal processes and information flow across different functional teams to ensure corporate goals and program requirements are met. The book of business represents $150 million of annual revenue and covers over 13,000 Medicare Beneficiaries in Maryland. This position currently has accountability for the 12 county MA-PD HMO and PPO products.

Competencies:

A. Education:

Master’s degree in business, health care administration, or a related field required.

B. Knowledge:

-Requires knowledge of managed care and Health Plan Operations

-Requires knowledge of the health care industry and Medicare program specifically.

-Requires knowledge of health care contract administration to include contractmodifications and regulatory oversight with federal contracts.

C. Skills:

  • Must have demonstrated strong creative thinking, problem solving and projectmanagement skills.
  • Has thorough knowledge of healthcare, insurance administration, strategic planning, financial management and reimbursement techniques, with specific experience in product management and development.
  • This position must possess a high level of skill in directing an overseeing of cross-functional strategy development and manage initiatives to ensure financial and market success of all lines of business.
  • Requires excellent oral, written and presentation skills as well as conceptual and analytical skills.
  • Requires standard word processing and spreadsheet application skills.

D. Required Licensure, Certification, Etc.:

None.

E. Work Experience:

Requires a minimum of 10 years’ experience in a managed care environment withprogressive responsibility with health plan operations and administration. Supervisory experience required.

Must have experience with overseeing corporate wide initiatives, directing professional staff and working within a wide variety of health care, financial, research, administrative, and communication disciplines.

Strong background on CMS compliance and exposure to federal contracts.

Dimensions:

A. Budget Responsibility:

Reviews historical administrative budget trends and makes recommendations regarding annual cost center budget.

B. Authority/Decision Making:

  • The position has complete freedom to identify, define and solve problems or challenges related to all Medicare Advantage Product Development and performance. The position will also lead all activities in identifying new product opportunities in the Medicare markets.
  • Develops and recommends Plan policies and procedures to senior management.
  • Makes decisions regarding beneficiary, provider, and payer issues and ProgramOffice administration.
  • Participates in developing functional unit operations supporting Medicare Advantage.
  • Works independently with very limited supervision and prioritizes own workload.
  • Oversee the activities with all functional areas that ensure corporate wide Medicare Advantage performance targets are met in the areas of product, profitability and market growth.
  • Assess the development of new CMS Medicare Advantage regulations and its impact to the HMO and PPO Product
  • Oversee the study of local and national markets, conduct market analysis and recommend new products and market strategies that will increase Senior Products revenue and profitability and maintain its leadership position.
  • Oversee the coordination of product and benefit mix strategy driving marketing and sales goals for Medicare eligible beneficiaries and group markets
  • Oversee that all Medicare Advantage products are developed and deliver thehighest levels of market need, administrative effectiveness, customer satisfaction, regulatory compliance and financial performance.
  • Provide the direction to and oversee the development of appropriate product and benefit structures given the future Medicare products and corporate goals.
  • Oversee the assessment of changes in ongoing revenue and cost trends, determine the drivers for the trends, and develop strategies necessary to ensure that corporate targets are met for this $150 million fully insured product.
  • Oversee all Performance Based Product Management reports development. Lead Cost/Revenue Based Product Management group, a gross functional workgroup that reports and oversees the strategy implementation.
  • Set performance targets for enrollment growth, as well as MLR and overall financial performance.
  • Oversee the timely identification of benefits and products for the Medicare Advantage, and ensure timely and accurate annual CMS benefit filing.
  • Ensure the development of provider strategy, Medical management strategies, Drug programs, and benefit and product design, to ensure performance targets set for the products are met.
  • Oversee the design and implementation of timely and accurate product reportingto Senior Management on product performance and trends.
  • Ensure timely implementation of benefit/product changes as outlined and approved by CMS or by the BID.
  • Oversee all internal and external product communications.
  • Ensure that the financial reimbursement arrangements and trends are incorporated into products and premium pricing and oversee the necessary strategy changes in medical management, provider pricing and benefit design as necessary.

C. Supervisory Responsibility:

Manages department staff and has responsibility for recruitment, hiring, supervision, firing, and performance management. Assigns and directs work and leads staff. Schedules and organizes work assignments in order to obtain turnaround time objectives. Ensures work is performed accurately and efficiently. Conducts performance appraisals and makes recommendations on selection, promotion, merit increases, and employee discipline. Ensure high level of staff motivation, training and development

Problem Solving:

Uses knowledge of health plan operations, knowledge of contract requirements, understanding of health plan performance drivers and critical thinking skills to resolve contractual and operational issues and to ensure targets are met.

Information Management:

Understands and interprets financial, utilization, and statistical reports.

Working Conditions:

Work requires attention to detail and mental acuity. Works in a normal environment where there are limited or no physical discomforts due to temperature, noise, dust and the like.

Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.