Posted in Other 30+ days ago.
Requisition #: 324489
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: Jan. 18, 2021
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.
Reporting to the Associate Vice President of Network Management, the Senior Director Provider Engagement and Clinical Transformation is responsible for the overall direction, execution and management of Provider Engagement and Clinical Transformation strategies. This is inclusive of strategies that improve the quality of service provided to our members while also ensuring our provider community is educated regarding our value-based initiatives, various benefit programs, product lines, medical and operating policies and procedures. This position is also responsible for ensuring our contracting providers are educated and engaged in all applicable incentive, pay for performance and risk programs. The Senior Director will be responsible for assisting our providers and integrated delivery systems with their clinical transformation which includes the assumption of care management administration, the assumption of risk and delivery of high quality and comprehensive care via the communication of known gaps in care and care opportunities as identified via evidence based programs. This position will work closely with the Sr Director of Contracting in the monitoring of the overall network performance as it relates to contracting, and quality and financial performance. This position will also work closely with the actuarial and finance departments in the development of incentive and risk based programs as well as the communication and dissemination of reports and performance data as it relates to those programs.
The primary focus of the Engagement team is provider satisfaction and servicing. The Sr Director will be responsible for working with key provider management representatives to address any health plan performance issues as it relates to claim payment timeliness and accuracy as well as appeals and grievance. This team is also responsible provider communication as it relates to policy and process changes which may impact their business administration activities.
As part of the Clinical Transformation responsibilities this position oversees the Clinical Transformation Consultants (CTC). The CTCs are responsible for working with key strategic provider partners to enable their success in value based arrangements and transformation initiatives. This staff and the Sr Director will meet regularly with providers to facilitate practice transformation efforts through hands-on expertise in quality management and clinical process improvement. Each will work in close partnership with Provider Practice Managers and staff to develop and implement transformation initiatives in support of accountable care products and membership growth.
The Sr Director Provider Engagement and Clinical Transformation serves as the subject matter advisor to programs such as Medicare STARS, HEDIS, risk revenue management, Value Based Programs, Incentive programs and Patient Centered Medical Home (PCMH) programs. This department leader will partner will partner with internal stakeholder and provider partners to meet or exceed JHHC targets and objectives. This role requires direct experience in quality management, data analytics, workflow optimization and clinical process improvement.
Requirements:
Dimensions:
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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