Director of Credentialing & Compliance — Hybrid

Johns Hopkins Health Plans; Washington (District of Columbia); Hybride; USD 162 000 - 191 000; Plein temps

Résumé du poste

Johns Hopkins Health Plans (JHHP) is seeking a Director of Credentialing to oversee all credentialing activities across Medicaid, Medicare, Commercial and Tricare lines. The role reports to the Executive Director, Health Services and supports NCQA, COMAR, CMS, and USFHP rules.

Hybrid role with possible remote work within approved states. The Director will own vendor relationships (CVO and system of record) and drive end-to-end credentialing processes, ensuring quality, speed and compliance.

Qualifications

• Bachelor's degree required in a related field.
• Master's degree preferred.
• Minimum 7 years in a managed care health plan environment with credentialing experience.
• 3 years of experience in a management capacity role.

Responsabilités

• Ensure compliance with credentialing regulations and standards.
• Serve as relationship owner of CVO vendor and manage SLAs.
• Collaborate with IT to enhance onboarding, updates and reporting systems.
• Coordinate with Provider Data Management, Provider Relations and Contracting for end-to-end onboarding.
• Lead special projects and geographic expansion related to credentialing.
• Oversee delegated credentialing organizations and data accuracy for enrollment changes.
• Maintain knowledge of NCQA, federal and state regulations and best practices.
• Lead the Credentialing Department in line with JHHP values and compliance.
• Develop and enforce departmental policies; monitor policy adherence.
• Implement ongoing QA from application to re-credentialing.

Connaissances

Leadership

Credentialing experience

Formation

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

Master's Degree (Preferred)

Description du poste

Johns Hopkins Health Plans (JHHP) is seeking a Director of Credentialing to oversee all credentialing activities across Medicaid, Medicare, Commercial and Tricare lines. The role reports to the Executive Director, Health Services and supports NCQA, COMAR, CMS, and USFHP rules.

Hybrid role with possible remote work within approved states. The Director will own vendor relationships (CVO and system of record) and drive end-to-end credentialing processes, ensuring quality, speed and compliance.