President, Johns Hopkins Health Plans

About Johns Hopkins Health Plans
The name Johns Hopkins is recognized worldwide as a dynamic leader in education and scientific innovation, clinical medicine and research and forward-thinking health care solutions. Since the founding of The Johns Hopkins Hospital in 1889, perhaps no other name has been so distinctly associated with world-changing medical advances, intellectual talent and academic integrity.
Established on this esteemed foundation, Johns Hopkins Health Plans is the $3 billion managed care and health services business of Johns Hopkins Medicine. A joint entity of the Johns Hopkins Health System and the Johns Hopkins University School of Medicine, Johns Hopkins Health Plans develops and administers managed care contracts with organizations, government programs and health care providers for almost 400,000 total members in Medicaid, Medicare, employer group and military health plans.
Along with its four health plans (US Family Health Plan, Employer Health Programs, Priority Partners, and Advantage MD), Johns Hopkins Health Plans has a Solutions and Innovations venture (https://www.johnshopkinssolutions.com/), which partners with Johns Hopkins faculty and providers, turning their research and ideas into digital products and solutions—such as the Johns Hopkins ACG® System, the world’s leading population health analytics software—that serve global customers

Position Summary

The President of Johns Hopkins Health Plans is responsible for the general management, people, operations, care management, strategic and business planning, and financial performance of all Johns Hopkins Medicine insurance and managed care products. These products include the Johns Hopkins Employer Health Programs (EHP), Johns Hopkins US Family Health Plan (USFHP, a TRICARE Prime plan), Priority Partners (Maryland Medicaid MCO), and Advantage MD (Medicare Advantage). The role oversees more than 1,000 employees, more than $3 billion in revenue, and almost 400,000 total member lives. The President reports to the JHHP Board of Directors and to the EVP/CFO of Johns Hopkins Health System and SVP/CFO of Johns Hopkins Medicine. The President will be an integral member of the Johns Hopkins Medicine senior executive team and must clearly embody Johns Hopkins’ larger tripartite mission of excellence in research, education, and patient care.

Responsibilities

1. Full P&L and general management responsibility for all Johns Hopkins insurance and managed care products under Johns Hopkins Health Plans (JHHP); oversight of services that directly support health plan management, including services delivered through shared-service arrangements.
2. Articulate the vision of JHHP as an insurer and manager in support of members’ health; lead the attainment of that vision.
3. Lead all aspects of the insurance and managed care businesses, including financial management; product development and management; actuarial, compliance, and regulatory functions; sales and marketing; clinical services; operations; pharmacy; and provider-network development and management.
4. Champion the culture and values of Johns Hopkins Medicine, demonstrating integrity and positive leadership.
5. Maintain consistent focus on the member and patient experience. Ensure delivery of the highest-quality medical care, strong patient and member satisfaction, and optimal outcomes, while improving efficiency and reducing medical costs.
6. Partner with Johns Hopkins Medicine's executive leadership team to define the business operating vision for Johns Hopkins Health Plans. Build the business plan that sets its strategic direction and organizational framework, lead implementation and ongoing operational management.
7. Lead the development and implementation of organizational design that substantially improves efficiency.
8. Mentor staff, strengthen internal leadership capabilities, and recruit experienced leaders as necessary.
9. Lead the ongoing design, engineering, and improvement of end-to-end core processes. Ensure that these processes align with strategic objectives and deliver a differentiated experience for providers and members across the company’s insurance and managed care products.
10. Report on JHHP’s financial performance and analytics. Develop annual operating and capital budgets with defined targets. Provide current and multiyear financial projections. Use financial analytics to identify performance drivers and support reporting and financial data strategy.
11. Identify revenue and cost management opportunities using data, utilization, and unit cost trends.
12. Provide actuarial support for the organization around pricing, reserving, forecasting, and financial risk management.
13. Assess how changing market conditions impact the current business model; identify opportunities to modify that model. Communicate resulting changes to internal stakeholders and governance bodies.
14. Partner effectively with the JHM delivery system to achieve the key priorities of the health plan products in support of the broader JHM strategic plan.
15. Maintain strong relationships with all external stakeholders and ensure that JHHP meets the needs of its partners/owners within its various insurance product lines.
16. Work closely with government regulatory and oversight agencies in multiple geographies, including the state of Maryland (Maryland Medicaid Administration, Public Health Services Administration (PHS), and Office of Health Care Quality (OHCQ)), as well as relevant federal agencies, such as CMS and HHS.
17. Develop and maintain strong relationships with the community, including federal and state leaders, providers, vendors, business partners, FQHCs, and community alliances.
18. Ensure operational results meet stated business objectives and planned ROI. Conduct ongoing, post-implementation reviews to assess each project’s realized value and performance against its business case.
19. Provide executive leadership of shared services from an insurance and managed care perspective; drive administrative efficiencies across the enterprise for these businesses. Help design and implement the segment's shared-services strategy, aligning it with overall company strategy and determining the appropriate mix of shared and direct services.

Qualifications

1. Bachelor’s degree, preferably in business or finance, with an advanced degree in business, medicine, public health, or a related discipline is strongly preferred, such as an MBA, MPH, or MD. Academic excellence and a demonstrated record of success are also strongly preferred.
2. 10+ years of experience in health insurance/managed care, with deep understanding of government programs, including Medicaid (multi-state experience preferred), Medicare Advantage, and senior products such as Part D, Medicare Supplement, Tricare, and dual-eligible programs. Experience with commercial/group products and self-insured offerings is a strong plus.
3. Experience as a senior healthcare leader, with responsibility for P&L and all functions of a health plan, health insurance company, or related organization. Experience as a CEO, president, or executive-level leader in a strategic business unit, region, or company in managed care, health plans, or group insurance is preferred.
4. Granular subject matter expertise in government programs, products, eligibility, funding, pricing, and the Affordable Care Act’s impact on program administration and expansion.
5. Strong financial skills, P&L experience, and experience managing operating and capital budgets in a large, complex organization. Strong analytical skills and proficiency in relevant software, systems, and data-management practices.
6. Ability to meet short- and long-term growth and profitability targets.
7. Proven success in health plan management, including direct responsibility for clinical services; pharmacy; claims and operations; customer service and call centers; network development and management; product development and management; sales and account management; marketing; vendor management; and strategic planning and development.
8. Ability and interest in working with top practicing physicians and physician leaders. Maintain an enterprise-wide focus on delivering world-class clinical care, research, and education programs.
9. Experience working in a shared-services model or matrixed organization is helpful, including experience collaborating with human resources, information technology, corporate finance, legal, and other corporate functions.
10. Working knowledge of federal and state policy initiatives that relate to the care and funding of those who qualify for government programs.
11. Knowledge of CMS and state regulations, compliance, star ratings, and risk adjustment. Experience in improving and maintaining various ratings that enhance quality and reimbursement.
12. Understanding of business principles and techniques of administration, organization, and management, including an in-depth understanding of the key business issues that exist in the rapidly changing healthcare industry.

Salary Range: Minimum /hour - Maximum /hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.