Requisition #: 182278
Location: Johns Hopkins Health Care, Glen Burnie, MD
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.
Master’s degree in business, health care administration, or a related field required.
-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.
D. Required Licensure, Certification, Etc.:
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.
A. Budget Responsibility:
Reviews historical administrative budget trends and makes recommendations regarding annual cost center budget.
B. Authority/Decision Making:
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
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.
Understands and interprets financial, utilization, and statistical reports.
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.