Manager, Provider Maintenance

Who you are:

As the Manager of Provider Maintenance and Credentialing for Johns Hopkins Health Plans, you are responsible for all Credentialing and Provider Maintenance activities. You have a deep understanding of credentialing and provider maintenance processes and their importance to a managed care organization. You are able to effectively communicate with internal and external sources regarding interpretation of policies and procedures and to identify potential problems. You pride yourself on your ability to develop and lead a team.

What you’ll do:

• Assure that all Credentialing and Provider Maintenance activities are performed within the credentialing specifications of National Committee for Quality Assurance (NCQA) guidelines, Code of Maryland Regulation (COMAR), Delmarva and US Family Health Plan
• (USFHP) Tricare regulations.
• Assure credentialing practices are also consistent with industry practice standards.
• Assure that all practitioners’ credentials are verified and reviewed by the Credentialing Committee/SCRC or their designee and; that provider demographic information is entered and maintained accurately and timely in various system databases including but not limited to of Vistar, , HealthLink and DHMH or any system used by the organization.Develop and implement policies and procedures to guide all credentialing and provider maintenance activities.
  • This includes accurate maintenance of the re-credentialing calendar/reports; and quarterly audits of the credentialing database to ensure timeliness and accuracy of credentialing activities.
• Represent the Credentialing and Provider Maintenance department in various meetings including external physician group meetings, internal committee meetings, and accreditation/auditing surveys including but not limited to NCQA, HEDIS, PWC and Delmarva.

What you’ll bring:

• 7+ years’ managed care experience.
• Thorough knowledge of managed care and the importance/interdependence of provider maintenance and credentialing, principles, methods and procedures.
• Bachelor’s degree; An Associate’s Degree in Business or related field or work experience may be substituted for equivalent work experience in lieu of education requirement.

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 500,000 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. 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.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.