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Cmo Johns Hopkins Health Plans

3 months ago

Hanover, United States Johns Hopkins Health Plans Full time

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3.2B business serving nearly 500,000 members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP is a leader in provider sponsored health plans—backed by the clinical expertise of Johns Hopkins Medicine—and is poised for future growth.

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.

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The Chief Medical Officer (CMO) of Johns Hopkins Health Plans is responsible for all Health Services functions in the organization and serves as the clinical leader for JHHP. The CMO plays a pivotal role in overseeing and optimizing the medical aspects of the health plan. This senior executive is responsible for developing and implementing clinical strategies to enhance the overall quality and efficiency of healthcare services provided by JHHP.

JHHP seeks to ensure high-quality, member-centric, equitable, and affordable health care for the members and communities we serve. As a provider-sponsored health plan, JHHP is uniquely positioned to improve provider collaboration and managed care effectiveness to support these objectives, including through innovative value-based arrangements. The CMO plays a critical role in driving these efforts, backed by the clinical expertise and national reputation of Johns Hopkins Medicine.

The CMO collaborates with medical professionals, operational groups at JHHP, Johns Hopkins Medicine staff, external provider partners, and other stakeholders to ensure that the health plan excels in clinical and quality performance, while aligning with industry standards and meeting regulatory requirements. The CMO leads initiatives to improve patient outcomes, control costs, and enhance the overall health and well-being of plan members. The CMO also develops JHHP’s clinical strategy, contributes to policy development, and fosters relationships with healthcare providers to establish a comprehensive and effective healthcare offering.

The CMO will also maintain accountability for the oversight of the Health Services division, including Pharmacy, Utilization Management, Care and Disease Management, Quality Improvement, Appeals & Grievances, Medical Policy and Provider Engagement and Clinical Transformation. The CMO recruits, selects and retains highly qualified professionals for leadership positions in Health Services. CMO has broad based authority in making decisions regarding utilization management and best practices in care management.

**REPORTING RELATIONSHIP AND KEY RESPONSIBILITIES**:
The Chief Medical Officer reports directly to the President & CEO of Johns Hopkins Health Plans. The CMO supervises 6 staff as direct reports and leads a team of 300 staff across Health Services. Johns Hopkins Health Plans is governed by a Board of Directors, comprised of both Johns Hopkins Medicine Directors and independent external Directors.

**Clinical Program Leadership**
- Leads JHHP clinical teams and programs including Utilization Management, Case Management, Disease Management, Behavioral Health, Pharmacy, Quality Improvement, Appeals & Grievances, Provider Engagement & Clinical Transformation and Medical Policy.
- In collaboration with the Executive Director of Medical Management and Associate CMO of Medical Management, the CMO is responsible for developing and maintaining an integrated UM, CM and DM program monitored by health outcomes and cost efficiency metrics.

Develop strategies to target high impact areas based on review of clinical data.

**Quality Improvement**
- In collaboration with the Associate CMO of Quality, provide leadership and oversight to the Office of Quality Transformation at JHHP. JHHP seeks to achieve exceptional performance across key Quality assessments, including NCQA, HEDIS, and CAHPS, as well as product-specific scores such as Medicare Stars and Maryland Medicaid PHIP. The CMO ensures JHHP achieves all State and Federal regulatory requirement, as well as accreditation requirements, related to Quality Improvement and Management.

Works with Board, committees of Board, network physicians and hospitals on the development of a continuous clinical quality improvement process.

**Clinical Strategy and Strategic Planning**
- Develops and maintains a partnership with JHM that leverages the expertise of the partners for the betterment of JHHP’s members’ health and development of a cutting edge, fully integrated health care system.
- CMO