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Job Details

Senior Director, Medicare Advantage Program Administration

Requisition #: 298688
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. 14, 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:

This position reports directly to the Vice President of Medicare Advantage. Ensures full execution of the Hopkins Health Advantage, Medicare Advantage contract with CMS and compliance with contract provisions. Executes overall program strategy with our internal and external partners. Provides direction to and serves as a resource for all operational units, senior management, lower-level staff and other stakeholders. Develop and maintain excellent internal and external relationships with key stakeholders including network providers, vendors, community organizations, Centers for Medicare and Medicaid Services and other government organizations. Ensures that all organizational process perform at the highest level to meet the CMS and customer needs. Responsible for coordinating with Centers for Medicare and Medicaid Services (CMS) regarding requirements such as reporting, benefit requirements and audits. Ensures the efficacy all internal processes and information flows across different functional teams to ensure all CMS requirements are met. Oversees compliance with data specification and reporting requirements.

Vendor Relations: Responsibilities include vendor relations associated with selecting, contracting, and evaluating benefits vendors (dental, vision, hearing, meals and fitness, etc); and managing relationships between ancillary vendors, clients and enrolled members. This position has responsibility for RFP development and response in relation to all products and services incorporated in all benefit plan packages

Task requirements for position:

  • Implements contract to ensure systems, policies and procedures are in place and functional. Includes: information systems and data reporting; plan benefits; primary care, specialty and ancillary networks; marketing; performance improvement; care/utilization management
  • Leads member retention committee to improve health plan operations and member satisfaction.
  • Serves as liaison to CMS regional office, departments within JHHC, and external customers. Identifies and responds to high-level service, claims, contract, network provider, and beneficiary issues.
  • Oversees the accuracy and appropriateness of all member communications.
  • Assists in the development of new contracting opportunities. Works with Network Development and legal representatives to ensure provider contracts address Plan requirements. Oversees CMS applications for service area expansions or new product filings.
  • Develops resources to ensure JHHC employees, network providers, beneficiaries, and others gain a sufficient understanding of Plan requirements, policies, and procedures. Develops provider and beneficiary education and marketing materials. Approves content of resources developed by the Provider Communications and Marketing departments and recommends design changes.
  • Formulates Plan policies and procedures and facilitates policy implementation.
  • Supports compliance with delegated functions such as claims, medical management, quality assurance, and network management.
  • Develops and manages routine monitoring/auditing mechanisms for meeting reporting requirements, performance standards, and all applicable deliverables.
  • Management of Department Staff According to JHHC Established Policies

Requirements:

  1. Education:

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

B. Knowledge:

Requires at least 5 to 7 years experience in managed care and of health plan operations in a management role. Requires knowledge of the health care industry and Medicare Advantage program specifically.

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

C. Skills:

Collaborates to ensure operational compliance with all necessary contractual requirements regarding state and federal regulatory agencies.

Requires excellent verbal and written communications skills to effectively interact with Johns Hopkins employees at all levels, Plan beneficiaries, Network providers and industry leaders

Requires excellent research skills.

Requires analytical and decision-making skills.

Requires ability to effectively facilitate meetings and to coordinate efforts among multiple departments.

Requires project management skills.

Requires standard word processing and spreadsheet application skills.

D. Required Licensure, Certification, Etc.:

None.

E. Work Experience:

Requires a minimum of 7 years’ experience in a managed Medicare environment with progressive responsibility with health plan operations and administration. Supervisory experience required.

F. Machines, Tools, Equipment:

N/A

Dimensions:

A. Budget Responsibility:

Reviews historical administrative budget trends and makes recommendations regarding annual cost center budget. Assists marketing team with development of marketing budget and monitors marketing budget monthly.

B. Authority/Decision Making Level:

Develops and recommends Plan policies and procedures to senior management. Makes decisions regarding contract interpretation and implementation. Makes decisions regarding beneficiary, provider, and payer issues and Program Office administration. Participates in developing functional unit operations. Works independently with very limited supervision and prioritizes own workload.

C. Supervisory Responsibility:

Manages Administrative Office 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.

Problem Solving:

Uses knowledge of health plan operations, knowledge of contract requirements, and critical thinking skills to resolve contractual and operational issues.

Information Management:

Understands and interprets financial, utilization, and statistical reports. Understands medical claims and associated medical coding.

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.

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