Quality Program Manager - Credentialing

The Quality Program Manager supports the quality, compliance, and continuous improvement of Credentialing operations, with a key focus on oversight of delegated credentialing functions. The role monitors compliance with organizational, contractual, regulatory, and accreditation requirements, including NCQA, CMS, DHA, Qlarant/MDH, ERISA, and other applicable standards.

Key responsibilities include delegation oversight and monitoring, accreditation and regulatory compliance, performance and timeliness monitoring, audit and re-accreditation readiness, evidence collection and validation, regulatory reporting, policy and procedure maintenance, and corrective action follow-up. As part of Delegated Credentialing Oversight, the Quality Program Manager supervises staff responsible for requesting, collecting, reviewing, evaluating, and reporting results of annual evaluations of entities to which JHHP delegates credentialing functions to ensure compliance with applicable NCQA standards and related regulatory requirements. The role establishes and manages delegates against defined expectations for quality, timeliness, accuracy, regulatory compliance, audit readiness, and required reporting, monitors performance against those expectations, identifies recurring or systemic performance issues, and drives escalation, correction action, and follow-through when standards are not met. The role also supports JHHP’s delegation strategy by evaluating prospective and existing arrangements, assessing whether delegation remains appropriate, and identifying opportunities to optimize the delegate portfolio based on compliance requirements, performance, operational burden, and organizational needs. The role also organizes and staffs pre-delegation assessments of entities being considered for delegated credentialing arrangements and monitors delegated entity and vendor performance, identified findings, compliance gaps, corrective actions, and required follow-through.

The Quality Program Manager reports the status of Delegated Credentialing Oversight and related compliance matters to JHHP management and governance and represents JHHP during external reviews of delegated credentialing operations. The role partners with Credentialing leadership, operational teams, Symplr, Analytics, and other cross-functional stakeholders to develop and validate data and reporting, coordinate system and documentation requirements, address identified gaps, and strengthen processes. The Quality Program Manager also prepares compliance findings, status updates, and supporting documentation for leadership and quality improvement activities while promoting consistent, accurate, and compliant Credentialing practices across all applicable regulatory and accreditation requirements.

Requirements:

Education:

Bachelor's Degree in Health Administration, Project Management or related degree.

Work Experience:

• One year of relevant education may be substituted for one year of required work experience or one year of relevant professional-level work experience may be substituted for one year of required education.
• Minimum of 7 Years of Experience Managing programs and projects that must include:
  • Minimum three (3) years providing project or team leadership
  • Minimum three (3) years’ experience working on project(s) involving project life cycle methodologies
  • Minimum three (3) years’ experience managing project budgets

Salary Range: Minimum 37.60/hour - Maximum 62.08/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.

The Hospital reserves the right to modify employee schedules as needed.

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.