Manager Credentialing Services-MCO

Johns Hopkins Health Plans is a leader in provider-sponsored health plans. 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. YOU belong here.

What awaits you:

• Work-life balance - This is a remote role-must report to the office in Hanover, MD on a quartertly basis/or as needed basis.
• Medical, Dental, and Vision Insurance.
• 403B Savings Plan w/employer contribution.
• Paid Time off & Paid holidays.
• Employee and Dependent Tuition assistance benefits.
• Health and wellness programs and MORE!

Who you are:

The Manager, Credentialing is responsible for accurate and timely credentialing and recredentialing activities for all providers and practitioners within the Johns Hopkins Health Plans network. This position ensures strict adherence to organizational credentialing policies and procedures, as well as compliance with the credentialing requirements set forth by our health plan partners and relevant regulatory and accrediting agencies

What you'll do:

Responsible for all credentialing and oversight activities for Medicaid, Medicare, Commercial, and Tricare lines of business. The Manager assures that all credentialing activities are performed within the credentialing specifications of National Committee for Quality Assurance (NCQA) guidelines, Code of Maryland Regulation (COMAR), QLARANT and US Family Health Plan (USFHP) Tricare regulations. This position ensures credentialing practices are also consistent with industry practice standards.

• Independently manage and review regulatory requests, audits conducted on behalf of JHHP, and monitor audits and reviews conducted by regulatory agencies of JHHP programs.
• Gather and review all appropriate contractual, internal policy and/or regulatory documentation pertinent to the assigned audit/monitoring process.
• Develop and implement policies and procedures to guide all credentialing activities
• Provide analytics and data driven insights to assist in the development of recommendations for process improvement within our credentialing and provider data
• Manage credentialing team to meet and exceed service requirements and functional objectives
• Monitor team production on a daily, weekly, and monthly basis and actively address individual production concerns and barriers to meeting metrics
• Prepare and deliver performance appraisals, working through all issues and managing performance in a way that provides the highest level of productivity and quality across the team
• Direct and mentor staff in a constructive and positive manner to foster employee relationships and development
• Serve as the lead on all credentialing-related matters, including audits, NCQA surveys, annual audits and regulatory requests
  
  

What you'll bring:

• At least 7 years of experience in a managed care or healthcare environment, with experience in provider credentialing.
• Minimum 5-years supervisory experience in a Medical Staff Administration Office required
• Requires understanding of credentialing and recredentialing, HEDIS, QLARANT, Symplr, and NCQA requirements. Must have experience in Microsoft Outlook, Teams, Word, and Excel.
• CPCS or CPMSM certification preferred. Lean Six Sigma Certification (e.g. green belt, black belt, master black belt or other) preferred.
• Comprehensive understanding of credentialing and their importance to a managed care organization
• Thorough knowledge of NCQA, Federal, State and other regulations required with direct experience in credentialing audits and NCQA survey preferred
• Strong analytical ability to resolve complex problems, gather and interpret data from different sources and to complete assigned tasks and projects
• Effectively motivate and manage staff of individual contributors to meet departmental and corporate objectives.

Education: Minimum of Associate's degree is required

Who we are:

Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine. JHHP is a $3B business serving over 400,000 active 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 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.