Director of Credentialing & Compliance (Hybrid)

Johns Hopkins Medicine; Hanover (MD); Hybrid; USD 162,000 - 191,000; Full time

Job summary

Johns Hopkins Health Plans, a part of Johns Hopkins Medicine, is seeking a Director of Credentialing who will lead credentialing activities across Medicaid, Medicare, commercial and TRICARE lines. The role focuses on NCQA/COMAR/CMS compliance, vendor relationships, and end-to-end onboarding and re-credentialing processes.

The position reports to the Executive Director, Health Services and requires collaboration with IT and key leadership teams.

Qualifications

• Bachelor's degree required; Master’s preferred.
• Minimum 7 years in a managed care health plan with credentialing experience.
• 3+ years in a management capacity.

Responsibilities

• Ensure compliance with credentialing regulations and standards.
• Oversee CVO vendor partner activities and SLAs.
• Collaborate with IT to improve onboarding, updates and reporting.
• Coordinate with Provider Data Management and Contracting for onboarding processes.
• Lead credentialing department and foster a compliant culture.
• Develop and enforce departmental policies; oversee QA and re-credentialing.

Skills

Regulatory compliance

Credentialing experience

Vendor management

Leadership

Education

Bachelor's Degree in Business Administration / Management or related field

Master's Degree

Job description

Johns Hopkins Health Plans, a part of Johns Hopkins Medicine, is seeking a Director of Credentialing who will lead credentialing activities across Medicaid, Medicare, commercial and TRICARE lines. The role focuses on NCQA/COMAR/CMS compliance, vendor relationships, and end-to-end onboarding and re-credentialing processes.

The position reports to the Executive Director, Health Services and requires collaboration with IT and key leadership teams.