Supervisor Credentialing

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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, applicants working from MD, DC, VA, DE, PA, and FL will be given first consideration.
• 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:

Reports to the Credentialing Manager. Performs Credentialing and Appeals and coordinates the full spectrum of the credentialing process for Johns Hopkins Health Plans in accordance with established policies and procedures and accreditation and regulatory requirements.

What you'll do:

• Manage workload on behalf of the Credentialing Manager by assigning tasks and organizing work assignments to appropriate staff and monitoring performance/deliverables.
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  Coach staff in appropriate procedures and computer systems data entry.

  
  
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  Ensure work is performed accurately and efficiently.

  
  
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  Contribute to the evaluation of performance management.

  
  
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  Coordinate and manages documentation and scheduling of the Credentialing Committee and Special Credentialing Review Committee meetings.

  
  
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  Track and investigate adverse information contained within providers credentialing files. Responsible for ongoing sanctions monitoring.

  
  
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  Responsible for tracking and presentation of appeal requests for credentialing decisions.

  
  
• Monitors and reports to the Manager incoming application activity, re-credentialing notification, staff work load, timeliness of credentialing activity, and accuracy of data processing.

What you'll bring:

• 3-5 years of credentialing experience. Demonstrated experience in the managed care credentialing environment such as a CVO, MCO, HMO or Hospital Medical Staffing. Previous supervisory experience preferred.
• Comprehensive understanding of credentialing policies and procedures as well as accreditation and regulatory requirements relating to managed care.
• Strong and organizational and personnel management skills and ability to manage a demanding workload with minimum supervision.
• Ability to effectively communicate with internal and external sources regarding interpretation of policies and procedures and to identify potential problems.
• Excellent written, oral and interpersonal skills. Good technical knowledge of automated support system.
• Requires analytical ability to coordinate information from variety of sources; detect errors and subtle inconsistencies in documentation; develop reports and documentation materials.

CPMSM or CPCS preferred

Requires a professional level of business administration and/or management generally obtained in the first two years of college or equivalent work-related experience. Bachelor's degree preferred.

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.

Salary Range: Minimum 24.56 per hour - Maximum 42.98 per hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility.

In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

JHM prioritizes the health and well-being of every employee. Come be healthy at Hopkins!

Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

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