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Job Details

Senior Health Programs Administrator, Medicare Advantage

Requisition #: 188376
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Sept. 13, 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.

Reports to Associate Vice President of Health Services, serves as the primary contact/liaison for Health Services and Advantage MD. Responsibility includes oversight of Health Services Advantage MD operations for Utilization Management, Care Management, Behavioral Health, Quality Improvement and Appeals. The Health Service Liaison establishes performance metrics to ensure excellent service delivery to our members, providers, and regulators. Also, he or she ensures Health Services maintains the highest possible standards of quality and operational compliance in alignment with Advantage MD’s and JHHC’s business strategy, regulatory requirements, and CMS Stars measures.

In cooperation with the Advantage MD administration and JHHC operations, the liaison ensures each Health Services department is aware of regulatory requirements and are meeting them timely. Works collaboratively with other areas of the organization to ensure they understand their roles and meet compliance requirements. Regularly reports results to executive leadership and makes recommendations for improvement if appropriate. This position will also serve as Health Services designated operations representative for CMS.

A. Education: A Bachelor’s degree in Business Management or related field is required. Master’s Degree in related field preferred.

B. Knowledge: Work requires the ability to work in a rapidly changing managed care environment while maintaining CMS requirements. Incumbent must be familiar with managed care products, operations, delivery systems, process improvement, organizational development and assessing customer expectations. Knowledge of production and documentation systems is desired.

C. Skills: Work requires excellent writing and verbal communication skills as well as analytical skills.

Work requires exceptional leadership, teamwork, interpersonal, influence and communication skills to allow incumbent to interact effectively with all levels of personnel and external contacts; demonstrated ability to persuade, communicate clearly, and cooperate with other colleagues.

D. Required Licensure, N/A

Certification, Etc.:

E. Work Experience: Work requires a minimum of five to 10 years of demonstrated performance experience within a health care and/or managed care environment, with at a minimum of 5 years management experience, leading people. Experience with Medicare and healthcare compliance as it relates to CMS. Medicare Advantage experience preferred. Must have experience in needs assessment and analysis, leadership of employees and full understanding of the quality expectations of an operations environment to include both employee expectations and regulatory requirements.

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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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