HCQA Regulatory Specialist, Sr

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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! First consideration given to applicants residing in MD, DC,VA, PA, DE and FL.
• 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 Sr. Regulatory/Accreditation Specialist for Johns Hopkins Health Plans, you are responsible for managing one or more regulatory/accreditation areas focused on assigned clinical or operational areas in compliance to state and federal requirements: including but not limited to; NCQA Health Plan Population Health Management, Utilization Management and Health Equity; EQRO Coordination of Care, Health Education, Utilization Review etc.

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

What you'll do:

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  Serve as the primary point of contact between the regulatory/accreditation team and collaborating partners within the organization

  
  
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  Monitor and maintain evidence for submission to external auditor

  
  
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  Support efforts across the organization relating to program requirements, quality improvement, implementation and reporting activities

  
  
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  Be responsible for assisting and preparing written reports summarizing findings that would be reported to various departments within JHHP

  
  
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  Meeting/committee preparation, coordination, and sharing summaries

  
  
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  Act as subject matter expert, handle complex assignments, and may assist training/mentoring department staff.

  
  
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  Assist in the development, maintenance and revision of policies and procedures to align with accreditation standards and regulatory requirements

  
  

What you bring:

• Minimum of 5 years of Accreditation support experience (NCQA) in a Managed Care Organization (MCO) or healthcare system
• Two or more years of External Quality Review Organization experience is preferred
• Demonstrated experience managing and facilitating onsite and virtual audits and surveys
• Demonstrated experience in reading and interpreting regulatory, accreditation and contractual standards.
• Demonstrated knowledge of the continuous quality improvement process.
• Certification is preferred -CPHQ (Certified Professional in Healthcare Quality), or other certifications relevant to this field.
• Preferred Certified Professional in Healthcare Quality, or Lean Six Sigma Certification
• Bachelor's degree in Business, Health Care Administration, Nursing or related field or equivalent education and experience (I.E. Associate Degree with 3+ years of accreditation support experience)

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 36.49 per hour - Maximum 60.26 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.