Director of Managed Care Contracting

2 weeks ago


Hanover, United States Johns Hopkins Health Plans Full time

Summary Reports to the AVP of 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.

Job Requirements 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. 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

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