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Director of Managed Care Contracting

3 months ago

Wilmington, North Carolina, United States Johns Hopkins Medicine Full time

Job Summary

Reports to the AVP, Network Management and is responsible for the overall direction and management of the contracting value-based care (VBC) and network development strategies. Responsibilities include negotiating provider reimbursement rates and contract terms, developing value-based care arrangements, planning, directing, organizing and evaluating the implementation of strategic objectives to ensure access to a quality cost efficient comprehensive provider network. Oversight and monitoring of network development and provider contracting. Ensures that cost containment initiatives are met for all LOB's. Formulates and implements policies and procedures to ensure compliance with applicable regulatory, contractual and accreditation standards and requirements. Acts as corporate authority on all reimbursement and payment methodologies, including incentive and Value-Based Care programs.

  • Responsible for oversight of network development, recruitment, contracting and retention activities.
  • Develop contract negotiation strategy to meet Strategic Goals.
  • With guidance, expand JHHP Value- Based Care program by partnering with new health care systems within Maryland and targeted states; implement programs and strategies related to manage care contracts.
  • Lead, develop and implement alternative payment methodologies (shared savings, risk sharing bundle arrangements)
  • Collaborate with key stakeholders, including finance, business Line of Business leads, operations and legal, to manage financial and operational, and legal provisions of the contracts. Implement contracting processes to effectively manage and maintain contract proposal, renewals and analysis, contract execution and configuration.
  • Knowledge of commercial products and government programs including Medicare, Medicaid and TriCare.
  • Assess market readiness in targeted states for network development and expansion
  • Ensure compliance with state and federal regulatory requirements related to applicable state law
  • Provide supervision and mentoring of Contracting Managers and staff

Qualifications

  • Bachelor's degree in related field. Master's degree in business in health care administration preferred.
  • Work requires a professional level of knowledge in business administration and/or management as normally acquired through 7-10 years managed care/health care experience with at least five of those years in a supervisory capacity.
  • Work requires demonstrated experience in the managed care environment; such as an Integrated Medical System in an administrative or finance setting or managed care organization/Insurance Company. Must have analytical and strong financial skills, contracting knowledge and over seven (7) years of progressive management experience. Must have experience with data analysis and statistics. Requires proven experience engaging providers in meaningful dialogue that results in collaborative relationships to support quality and financial initiatives.
  • Knowledge of complex managed care concepts, including provider recruitment, network development, and managed care contractual process; including alternative reimbursement models associated with incentive and risk-based programs.
  • Demonstrated knowledge of value-based care reimbursement models. Healthcare contract experience in commercial and government contracting.
  • Knowledge of multi-state and federal regulatory requirements. Broad contracting experience in unregulated markets.

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. 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.

Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).