Contracting Specialist III-Managed Care

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 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:

Responsible for maintaining 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 JHHP’s strategic initiatives, and negotiating within the financial parameters to gain maximum cost efficiency and support JHHP’s goals and strategic initiatives.

As a Contract Specialist III, you will negotiate complex contracts including Value based Contracts, Cost Reduction Related Contracts, “Risk” agreements, etc. Works in conjunction with analytics and the Finance team to develop financial models analyzing Value Based Contracts shared savings, Capitation, bundled pricing, and other reimbursement methodologies. Negotiates complex managed care contracts securing optimal reimbursement and driving high Quality outcomes. Leads the implementation process to ensure all contracts are loaded into the provider maintenance Systems, reporting is implemented and contract is operational. Manages the post implementation Process of all assigned Complex Contracts. Manages and audits the loading and updates of pricing and reimbursement terms to ensure contract compliance and appropriate reimbursement. Actively works within Networks Management and is the JHHP Networks management representative to address any questions or concerns related to complex contracts.

What you’ll do:

• Engage and develop JHHP contractual relationships with a wide range of behavioral health providers including psychiatrists, therapist, residential treatment facilities, and outpatient clinics.
• Lead the implementation process to ensure all contracts are loaded into the provider maintenance Systems, reporting is implemented, and contract is operational.
• Manage the post implementation process of all assigned complex contracts including behavioral health providers and /or other specialized provider types
• Manage and audit the 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 you’ll bring:

• More than five years prior experience in Contracting/Network Development in healthcare delivery program or insurance setting, experience in developing various reimbursement standards. May provide guidance or expertise to less experienced specialists.
• Experience should include: Provider contracting, negotiating complex fee schedules, knowledge of managed care concepts and billing information systems. Value Based/Gain Share/Risk contracting experience preferred.
• 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.

Bachelor’s degree in business management or healthcare administration or related discipline preferred. Experience can be used in lieu of education on a 2:1 basis. (8 relevant YOE=4 year degree)

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 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 33.90/hour - Maximum 55.98/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 drug-free workplace employers.