Managed Care Contracting Specialist II

Johns Hopkins Health Plansis 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 belong here.

What awaits you:

• Work-life balance -This is a remote role. Applicants living in MD VA DC PA DE or FL will be given first consideration. Quarterly travel to the Hanover MD office may be required.
• 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:

As a Contract Specialist II you will be maintaining a primary responsibility for the development of provider networks that includes recruitment negotiating complex contracts contacting and re-contracting of current provider network. The position is responsible for reviewing network adequacy and determining recruitment needs within all specialties taking appropriate actions to recruit new providers to fill in gaps to meet accreditation standards and JHHPs strategic initiatives and negotiating within the financial parameters to gain maximum cost efficiency and support JHHPs goals and strategic initiatives.

What youll do:

• Engage and develop JHHP contractual relationships with a wide range of behavioral health providers including psychiatrists therapist residential treatment facilities and outpatient clinics.
• Leadthe implementation process to ensure all contracts are loaded into the provider maintenance Systems reporting is implemented and contract is operational.
• Managethe post implementation process of all assigned complex contracts including behavioral health providers and /or other specialized provider types
• Manageand auditthe loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate reimbursement.
• Actively work within Networks Management and is the JHHP Networks management representative to address any questions or concerns related to complex contracts.

What youll bring:

• Requires a minimum of three to five years prior experience in Contracting/Network Development in healthcare delivery program or insurance setting experience in developing various reimbursement standards.
• Requires a strong ability to negotiate high dollar reimbursement sound knowledge of successful selling and negotiation techniques and an awareness of healthcare contracting terms.
• Ability to negotiate provider contract fee schedules and performance guarantees.
• Strong ability to develop unique alternative reimbursement standards that are cost efficient.
• Familiarity and knowledge of managed care concepts required
• Understanding of Mental Health Parity and Addiction Equity Act (MHPAEA) and its implications on contracting.
• Knowledge of HIPAA CMS guidelines and state-specific Medicaid managed care requirements.
• Competence in analyzing claims utilization trends cost data and competitive market rates to support contract terms.
• Ability to use data to develop pricing proposals and assess financial impacts of contracting decisions
• Excellent interpersonal written and verbal communication skills.

Bachelors degree required- in business management or healthcare administration preferred.

Experience with alternative payment models (APMs) value-based contracting and bundled payments in behavioral health highly preferred

Skilled in network adequacy analysis and identifying strategic network expansion opportunities 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 500000 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 /hour - Maximum /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.

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 an Equal Opportunity 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.