DIRECTOR OF MEDICAID AND COMMERCIAL QUALITY PERFORMANCE

2 weeks ago

MD United States Johns Hopkins Health System Full time
Job Summary

Under the direction of the Associate Chief Medical Officer, Quality & Transformation, this execution-focused position of the Quality Performance Director, for Medicaid, USFHP & EHP will support quality performance management for the Medicaid line of business, Priority Partners Managed Care organization (PPMCO), TRICARE Prime (USFHP), and Commercial (Employer Health Program) lines of business for JHHP.

Responsible for developing and driving the enterprise-wide Medicaid VBP, USFHP, and EHP performance improvement and implementation through evaluating strategies, external capabilities and vendors to help drive best-in-industry performance. Responsible for identifying innovative strategies to set market leading performance for PPMCO VBP, USFHP, and EHP measures and initiatives. Must have deep industry connections to cutting edge strategies and external partners that can accelerate and maintain as an industry leader. Works collaboratively with PPMCO, USFHP, and EHP, enterprise leaders, and internal leadership to establish baseline capabilities and develop strategies for capability enhancement. Extensive market knowledge and research capability is necessary to best be able to evaluate opportunities. Collaborates and coordinates work with peers, other departments within matrix/shared service partners (including but not limited to Provider Relations, Pharmacy, Care Management, Utilization Management, Compliance, Appeals, Marketing and Communications, and IT).

This position will be responsible for the planning, development and execution of activities that support the Maryland Department of Health (MDH) or External Quality Review Organization (EQRO), Qlarant required deliverables such as audits, corrective actions, performance improvement plans (PIPs) as well as VBP strategies. In addition, this position will serve as quality lead for USFHP and EHP deliverables related to quality improvement.

Qualifications
  • Bachelor's degree in health administration or a related field required. Advanced coursework and/or Master's degree preferred. Minimum 3-5 years of managed care experience, specifically in government programs, is required. + 3 - 5 years in Strategic Planning, + 1 - 3 years in Operational Excellence, + 1 - 3 Vendor Management, + 1 - 3 years in Medicare, Medicaid and Commercial;
  • TRICARE/TRICARE PRIME experience a plus
  • Minimum of 8- 10 years of healthcare experience with thorough knowledge of healthcare quality improvement, industry standard performance measures, healthcare reimbursement including valued based purchasing methodology and management, managed care, and tactics that result in member and provider engagement. Prefer 3-5 year supervisory experience and experience with government contracts related to healthcare deliverables

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.

Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).

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