Director of Medicare Advantage and Healthcare Operations

2 months ago

Wilmington, North Carolina, United States Johns Hopkins Medicine Full time

Job Summary

Reports to Sr. Director of Operations, serves as the primary contact/liaison for JHHC and the BPO vendor. Responsibility includes oversight of Medicare Advantage Operations managing the BPO relationship supporting operations and other Medicare Advantage functions. Also establishes performance metrics for both the vendor and internal functions to ensure excellent service delivery to our members and providers. Also ensures JHHC maintains the highest possible standards of quality and operational compliance in line with JHHC's business direction, regulatory and CMS STARS rating measures.

In cooperation with the Compliance Office ensures each department is aware of regulatory requirements and are meeting them timely. Also working with the Compliance Office disseminates CMS memos and ensures all operations areas are educated on Medicare guidelines and changes. 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 JHHC designated operations representative for CMS.

Qualifications

  • A Bachelor's degree in Business Management or related field is required. Master's Degree in
  • related field preferred.
  • 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. Experience managing BPO or remote processing sites desired.
  • Work requires the ability to work in a rapidly changing managed care environment while maintaining CMS requirements. Must be familiar with managed care products, operations, delivery systems, process improvement, organizational development and assessing customer expectations. Knowledge of CMS, Health Plan Management System (HPMS) desired.

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