Requisition #: 544728
Location: Johns Hopkins Health Care, Hanover, MD 21076
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time
Weekend Work Required: No
Date Posted: June 17, 2022
Who you are:
You are a subject matter expert when it comes to health plan contracting regulations for delegated entities (DE); you are able to apply your skills to audit existing contracts and assist in the creation of new contracts. You are an individual contributor who can be counted on, and you also excel at collaboration to get the work done.
What you'll do:
You will manage the DE on-boarding and continuous contracting oversight. This will include, but is not limited to the following:
Participation in the procurement of future DE's;
Performs pre-contracting DE status determination on all vendor contract requests to ensure that when a current vendor changes its provided services, it does not rise to the level of a DE without the appropriate checks;
Performs pre-contracting due diligence gathering and assessments in conjunction with IT Security, Compliance, and Quality;
Performs the first review of any DE identified vendor contract to ensure the appropriate regulatory and accreditation language is present;
Performs vendor risk assessments on every DE vendor;
Ensures DE vendors undergo standardized performance reviews on a set schedule; and
Assists Compliance, IT Security, and Quality in any audit requiring DE vendor contract information, including the provision of the risk assessments and performance reviews.
What you bring:
Experience working with Medicare-vendor contracting requirements.
Experience and knowledge of NCQA contracting requirements.
Health Insurance Contracting is highly preferred:
Compliance, Legal, or Managed Care contracting experience would also be considered
Strong interpersonal skills.
Expertise in the following Microsoft programs:
PowerPoint, Word, and Excel
Experience using contracting management software.
Requires a B.S. degree in business, health care administration, or a related field.
Who we are:
Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC 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. JHHC 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 HealthCare, 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, JHHC is the place to call home.
Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).
If you reside in one of the following states, this position can be considered for virtual work: MD, VA, FL, PA, DE, or District of Columbia
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Medicine