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Job Details

Assistant Director, Medicare Star Ratings

Requisition #: 286806
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Leadership
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Nov. 6, 2020

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.

Position Summary:

The Assistant Director of Medicare, Star Ratings is a highly visible, senior, strategic leadership role reporting to the Director, Quality Improvement (QI) and is responsible for leading all aspects of the Medicare Star Ratings program with a primary focus on execution of program strategy. The Assistant Director is accountable for the overall Stars performance and will be responsible for the following:

  • Works with the Director, QI to define the Star Ratings strategy for the organization, including annual and long-term strategic plans for performance improvement
  • Flawlessly executes the defined strategy to deliver the set annual performance goals of the health plan.
  • Identifying, creating and executing work plans, , tracking, and reporting metrics, as well as managing all Star Ratings initiatives
  • 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 member centric strategies to engage, educate, and motivate providers to positively impact Star Ratings
  • Lead, coach, and teach measure owners and team’s end-to-end process improvement cycle such as the definition, documentation, measurement, improvement, and control of processes aimed at optimizing the quality of the Medicare member/provider engagement programs.
  • Effectively managing vendors and holding them accountable for high performance based on the strong operational knowledge of the health plan.
  • Understands overall organizational processes, operations and challenges that may impact star ratings and provides leadership with visibility on the potential impacts (positive or negative) along with the mitigation efforts.
  • Driving positive culture transformation and corporate-wide awareness of Stars through education, communication, and employee engagement


Requirements:

  1. Education:

Bachelor’s degree in health administration or a related field required. Advanced coursework and/or Master’s degree desirable. Minimum 3-5 years of managed care experience, specifically in government programs, is required.

B. Knowledge:

Robust knowledge and strong experience with Medicare Advantage, and specific experience with Star Ratings is a MUST, along with extensive knowledge in Medicare compliance, health plan operations, and quality improvement activities

Detailed, “SME-level” knowledge of HEDIS, CAHPS, HOS, Part D, and Admin. measures

Strong knowledge and understanding as well as ability to interpret Federal and state regulations.

C. Skills:

Strong knowledge and understanding of managed care principles and industry evolution is essential.

Exceptional analytical, strong planning and organization skills. Ability to develop and lead high performing teams

Ability to define and promote a strong vision across a matrix organization with competing priorities

Excellent written and verbal skills and ability to interact effectively with all levels of employees

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

Ability to anticipate financial reporting, forecasting, and operational issues, assess implications, determine impact and develop and implement appropriate action plan.

Must be a results oriented individual.

D. Required Licensure, Certification, Etc.:

N/A

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.

Dimensions:

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.

Problem Solving:

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.

Information Management:

Must be able to draw conclusions from data, track trends and determine solutions.

Working Conditions:

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

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.

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