Niesha N. Johnson
Randallstown
Summary
Results-oriented Value Based Transformation Manager with expertise in provider performance management and value-based care programs. Utilizes SQL for data analysis and cultivates strong stakeholder relationships, enhancing quality outcomes and member experience. Demonstrates strategic problem-solving and effective leadership.
Overview
21
21
years of professional experience
Work History
Value Based Transformation Manager
Johns Hopkins Health Plan
06.2023 - 10.2025
- Lead healthcare transformation initiatives to improve quality, enhance member experience, reduce costs, and optimize provider performance across Medicare Advantage and value-based care programs.
- Serve as a subject matter expert in Medicare STARS, HEDIS, risk adjustment revenue, value-based/incentive programs, and Patient-Centered Medical Home (PCMH) models.
- Drive performance to meet and exceed Johns Hopkins Health Plan targets and strategic objectives.
- Analyzed provider performance through weekly and quarterly MRP reporting; identified gaps and implemented targeted strategies that enhanced care quality.
- Collaborated with providers to review performance data, close care gaps, and maximize program incentives, contributing to improved quality outcomes.
- Build and sustain strong relationships with internal and external stakeholders, including senior leadership and provider partners.
- Developed and presented executive-level PowerPoint presentations to providers and leadership, translating complex data into actionable insights that informed strategic decisions.
- Lead contract negotiations with Johns Hopkins US Family Health Plan (TRICARE), ensuring favorable terms and alignment with organizational goals.
Provider Relations Contract Manager
United Healthcare Optum
06.2016 - 06.2023
- Negotiate and manage contractual agreements with skilled nursing facilities, including value-based arrangements (shared savings, gainshare, premium dividend), capitation, per diem, and incentive-based programs (e.g., medication adherence).
- Manage a portfolio of 25 skilled nursing facilities across the Mid-Atlantic region, serving as the primary point of contact for all operational, contractual, and performance-related matters.
- Maintain in-depth knowledge of Medicare regulations and ensure compliance across all contracted facilities; proactively identify and mitigate compliance risks.
- Analyzed facility performance and utilization trends through biweekly CRM reviews, collaborated with key stakeholders to address high-utilization and performance gaps.
- Determine contract rates based on eligible resident populations within the UnitedHealth Group / Optum Medicare Advantage program.
- Lead contract lifecycle management, including rate negotiations, annual performance reviews, and renegotiation of terms (per diem or per member per month) after initial 12-month periods.
- Oversee contracts ranging from 1 to 7 years, ensuring alignment with organizational goals and Centers for Medicare & Medicaid Services (CMS) guidelines.
- Facilitate implementation and onboarding meetings with facility administrators and leadership, integrating new partners into the Medicare Advantage Institutional Special Needs Plan (ISNP) network.
- Develop and deliver training materials to educate clinical and administrative staff on program updates, new products, and performance expectations.
- Present utilization reports, quarterly incentive reviews, and performance updates during business review meetings and educational sessions.
- Monitored key performance indicators, including medication adherence, hospitalization rates, diabetes, and hypertension outcomes, partnered with stakeholders to enhance outcomes.
- Analyze data from internal systems and develop comprehensive quarterly reports, including tables and visualizations, for senior leadership and facility stakeholders.
- Support financial planning by contributing to annual operating budgets and forecasting processes.
- Designed and implemented provider engagement strategies to strengthen relationships with physicians, hospitals, and ancillary providers, contributing to overall organizational performance.
- Led a team of 7 during the COVID-19 pandemic, developing 'treat-in-place' strategies for skilled nursing facilities that reduced costs and improved patient care outcomes.
- Recognized with the 2020 Bravo Award for Collaboration and Performance.
Research Coordinator
Health Analytics
08.2014 - 02.2016
- Conducted clinical studies of Federal, State and local program regulations while maintaining project budget for a study designed to capture data through a survey panel from patients who were diagnosed with diabetes rheumatoid arthritis, Crohn's disease, and cancer.
- Monitored and tracked outcomes of clinical trials while providing administrative support to ensure adherence to study requirements.
- Developed and created clinical project documentation in accordance with industry standards and developed clinical health study proposals in accordance with program guidelines.
- Verified and collected quantitative data to ensure accuracy of research findings and delivered comprehensive reports to stakeholders.
- Reviewed and analyzed contractual agreements for compliance with program regulations while maintaining databases to protect client confidentiality.
Network Operations Specialist
Health-Spring/Cigna Health
12.2012 - 03.2014
- Created monthly reports and analyzed provider quarterly production results to support internal and external stakeholders.
- Conducted compliance reviews at over 30 local provider locations while investigating and resolving provider issues related to claims, contracts, and information change requests.
- Prepared charts, forecasts, and documents to assist in formalizing protocols and procedures for hospital admissions, hospice care, and other medical services.
- Developed, planned and issued changes to operational policies and protocol to streamline communication to stakeholders.
- Designed and implemented reporting mechanisms so that providers can access needed data and information.
Medical Coordinator II
Johns Hopkins Bayview Medical Center
10.2010 - 12.2012
- Coordinated 4 provider surgery schedules, facilitating preparation for over 500 patients annually.
- Prepared and secured authorizations and medical documentation to support timely commencement of surgeries.
- Assisted during surgical procedures in the operating room by escorting patients, ensuring consent signatures, and securing patients' belongings.
- Processed health care insurance claims, ensuring timely payments for surgical procedures and managing disputes for denied claims.
- Contributed as a board member on the Employee Engagement Committee of Johns Hopkins Hospital.
Unit Manager
Charlestown Retirement Community
01.2005 - 07.2010
- Led team of six unit managers in administering unit protocol, ensuring compliance and operational efficiency.
- Managed residents' medical charts, ensuring data accuracy and compliance with healthcare regulations through collaboration with physicians, dieticians, and social workers.
- Fostered partnerships with healthcare professionals, enhancing collaborative care for residents.
- Acquired essential medical supplies for residents in the unit.
- Transcribed medical orders written by physicians onto a Cardex and processed medical claims and health forms needed for healthcare insurance companies.
Education
Master of Business Administration -
University of Phoenix
Columbia, MD01-2015
Bachelor of Arts - Health and Humanity Management
University of Phoenix
Columbia, MD01-2012
Associate of Arts - Healthcare Management
University of Phoenix
Columbia, MD01-2010
Skills
- Value-based care
- Healthcare Analytics
- Healthcare Data Management
- Revenue Cycle Management
- Quality Improvement Initiatives
- Patient Engagement Tools
- SQL/NDB
- Data analysis
- Healthcare Contract Negotiation
- Problem solving
Greek Organization Affiliation
Alpha Kappa Alpha Sorority Incorporated, Upsilon Epsilon Omega Chapter, 12/2025
Volunteer Experience
- Alzheimer's Association, Walk to End Alzheimer's, Ellicott City, MD, 2019-Present
- Ebenezer AME Church, Soup Kitchen Volunteer, Baltimore, MD, 2014-2018
References
Available Upon Request
Programs And Software Experience
- Meditech
- Salesforce Customer Relations Management Software (advanced)
- COSMOS (proficient)
- SQL/NDB (proficient)
- ISET Medical Billing Software (proficient)
- Emptoris Contract Management System (advanced)
Highlighted Experience
Results-driven healthcare professional with 15+ years of experience in claims management and provider contracting within highly regulated environments. Strong background in data analysis and financial reporting, with a proven ability to translate complex information into actionable insights that improve operational performance. Proficient in Microsoft Office Suite (Excel, PowerPoint, Word, MS Project) and SharePoint for reporting and collaboration. Recognized for exceptional communication skills, with the ability to engage effectively at all levels, including senior leadership. Demonstrates strong leadership, problem-solving, and meeting facilitation skills to drive strategic initiatives and organizational success.
Timeline
Value Based Transformation Manager
Johns Hopkins Health Plan
06.2023 - 10.2025
Provider Relations Contract Manager
United Healthcare Optum
06.2016 - 06.2023
Research Coordinator
Health Analytics
08.2014 - 02.2016
Network Operations Specialist
Health-Spring/Cigna Health
12.2012 - 03.2014
Medical Coordinator II
Johns Hopkins Bayview Medical Center
10.2010 - 12.2012
Unit Manager
Charlestown Retirement Community
01.2005 - 07.2010
Master of Business Administration -
University of Phoenix
Bachelor of Arts - Health and Humanity Management
University of Phoenix
Associate of Arts - Healthcare Management
University of Phoenix