Posted in Other 5 days ago.
Type: Full Time
Requisition #: 282623
Location: Johns Hopkins Health Care, Hanover, MD 21076
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: Sept. 15, 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.
The Medical Director of Johns Hopkins HealthCare LLC (JHHC) will work alongside the other medical directors under the direction of the Associate Chief Medical Officer (ACMO). The ACMO reports to the CMO for Johns Hopkins Healthcare.
The Medical Director will be responsible to ensure that the provision of health care service to the membership is compliant with the medical policies and standards established by the Medical Policy Committee. This will be accomplished by participating in medical necessity reviews, including pre-service reviews, concurrent reviews of inpatient and post-acute care, and appeals.
Working with the ACMO, the Medical Director will propose policies and standards for review and resolution to the committee and communicate these policies and standards to physicians participating in the JHHC network.
The Medical Director will work with the ACMO and Assistant Vice President of Health Services for JHHC and other Medical Directors to oversee all activities of utilization review, care management and quality to determine the medical effectiveness of proposed treatments and approve care management plans. The critical responsibility will be the management of care delivery in a cost effective and quality assured system that will assist JHHC to achieve its corporate mission of serving the health needs of enrollees.
Requires a Medical Degree from an accredited Medical School. MBA, MPH or similar preferred.
Knowledge of managed care concepts and care management activities.
Skilled in coordinating and collaborating with physicians in both the community and academic medical centers.
D. Required Licensure, Certification, Etc.:
Unrestricted license as M.D. If licensed outside of Maryland, must be willing to apply for a Maryland M.D. license immeediately upon acceptance of employment offer. Board Certification in a clinical specialty required, with preference for Family Practice, Internal Medicine/Pediatrics and Internal Medicine.
E. Work Experience:
Five years or more experience in managed care, care management, and medical policy development. Experience with Medicaid preferred. Some clinical practice experience preferred.
F. Machines, Tools, Equipment:
General office equipment.
A. Budget Responsibility:
B. Authority/Decision Making Level:
Broad based authority in making decisions regarding utilization management and best practices in care management.
C. Supervisory Responsibility:
May assign work to support staff.
Uses specific body of knowledge and defined policies and procedures to develop coordinate programs for target populations.
Must be able to utilize multiple software programs and understand patient data reports, utilization reports and measure and assess outcomes.
Works in normal environment where there are no physical discomforts due to dust, dirt, noise and the like.
Work is sedentary in nature; however, some standing, stooping, and bending is required. The position requires activity, pulling and filing.
Work requires concentration and constant attention to accuracy and detail for extended periods of time.
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.