Sr Director Provider Relations And Clinical Transformation

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:

• Education:

Bachelor Degree in Business, Finance or Health Care Administration

B. Knowledge:

Knowledge of contracting methodologies and pricing strategies and the provider community.

Experience interpreting and utilizing clinical data analytics and outcome measures to drive change.

Demonstrated experience in the Managed Care environment. Provider Relations and contracting knowledge

Budget management experience

C. Skills:

Customer mindset with proven ability to build positive relationships, gain trust and respect and influence others.

Ability to interact with provider management at all levels in discussions and presentations related to the clinical side of their value based arrangements

Strong communication, relationship building and facilitation skills

Independent decision maker

D. Required Licensure, Certification, Etc.:

NA

E. Work Experience:

7+ years of progressive management experience in health care or insurance industries and 4 years in contract administration and provider relations with strong financial managed care knowledge.

Preferred Job Requirements

Master’s Degree.

Diplomacy skills as well as involvement in the community through participation in community activities.

Visibility and commitment to projects and programs which promote and enhance the business and community environment.

F. Machines, Tools, Equipment:

PC, PC applications, and general office equipment.

Dimensions:

A. Budget Responsibility:

Budget Responsibility: Responsible for meeting JHHC and JHM Capital and Operating plan, including managing departmental budget of $3million plus to meet defined targets. Responsible to manage and negotiate multimillion dollar hospital and facility contracts to stay within LOB Budget and cost savings initiatives.

B. Authority/Decision Making Level:

Has authority for and required to make independent decisions at management level. Recommend and implement Corporate Policies and Procedures. Responsible for directing and managing Board Committees.

C. Supervisory Responsibility:

Has responsibility for hiring, firing, performance management and results of assigned areas; including direct management of assistant director and manager of department.

Problem Solving:

Must have strong problem solving skills for resolution of complex issues.

Information Management:

Requires strong data and financial analysis skills with a sophisticated understanding of reimbursement methodologies, including Incentive and Risk based programs. Must have experience with Provider Profiling tools and Business Intelligence reporting software.

Working Conditions:

Works in normal environment where there are no physical discomforts due to dust, dirt, noise and the like. Work requires moderate level of travel with some overnight travel as required. Work is sedentary in nature; however, some standing, stooping, and bending are 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.