Healthcare Services Vendor Manager

Healthcare Vendor Manager I or II (DOE)Remote only within ID, OR, UT, WA At Cambia, our members need us more than ever, and to continue serving them, we need to be vaccinated. Following federal mandate, all Cambia Health Solutions employees, including 100% remote workers, need to be fully vaccinated for COVID-19 by 1/1/22. Healthcare Services Vendor Manager I provides support related to program evaluation, development, ensure regulatory compliance, implementation and management. Supports the implementation of new programs and the enhancement of existing programs delivered internally, through a vendor relationship, or in a hybrid model. Build and own relationships with internal customers in Healthcare Services management, vendors, vendor management and numerous departments within the company to achieve successful implementation of new or enhancement of existing programsResponsibilitiesEffectively collaborates with internal program leaders, vendors and/or a combination of internal and external resources to resolve implementation, compliance, and program design conjunction with internal operational leaders and/or vendor management, develops monitoring and control procedures. Manage moderate to complex vendor relationships ensuring the relentless pursuit of desired clinical outcomes, cost savings and favorable terms. Educates and trains the leadership, staff, and business associates regarding new program elements and implementation.Maintains a system for ongoing data/statistical reporting and program assessment. Responsible for the development and maintenance of vendor program documents, reports, etc.Collaborates with internal & external business partners on the collection, analysis, and maintenance of relevant data.Provides leadership and operational oversight of vendors. Manages vendor relationships in collaboration with vendor management. Leads the daily interface with vendor partners.Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards. Utilizes Cambia processes and knowledge to ensure compliance with program design, contractual requirements, accreditation standards and accepted standards of care.Drives continuous improvement in all aspects of the vendor oversight process, including the evaluation of clinical and non-clinical program outcomes.Additional Responsibilities for level IIEffectively collaborates with internal program leaders, vendors and/or a combination of internal and external resources to resolve productivity conjunction with internal operational leaders and/or vendor management, develops monitoring and control procedures.Acts as a resource to other business owners and may mentor less experienced staff members.Develop sustainable strategies for vendor performance management of moderately complex vendors that include regular score-carding of performance, SLA monitoring, and supplier business reviews for each vendor managed.Drive continuous improvement in all aspects of the supplier performance management process including the evaluation of existing risk for mitigation opportunities.Serves as mentor to more junior staff. RequirementsAbility to evaluate program effectiveness, identify issues and opportunities, and work to continuously improve programs offered. Ability to analyze financial measures associated with process improvement activities.Strong communication and facilitation skills, including the ability to resolve issues with diplomacy and persuasiveness, and build consensus among groups of diverse stakeholders.Ability to track and analyze performance data and translate data into insights for decision making.Knowledge of health insurance industry trends and technology. Experience in areas of Healthcare Services practices.Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to manage compliant operations. NCQA and/or HEDIS accreditation experience preferred.Ability to coordinate cross-functionally to drive solutions and resolve issues in a timely and effective manner.Demonstrated experience in complex program oversight.Familiarity with contract language and understands and can identify contractual risk, with an ability to mitigate risk.Demonstrated experience in designing and implementing process and technology improvement solutions.Strong knowledge of data abstraction and quantitative, qualitative and analytical skills.Additional Minimum Requirements for Healthcare Services Vendor Manager IIDemonstrated ability to effectively manage multiple high-profile utilization management vendors with diverse vendor management responsibilities and complex vendor deliverablesDemonstrated ability to effectively handle major vendor performance issues with proper escalation and resolutionProven experience in defining, developing and managing service level agreements (SLAs), including managing medium complex agreementsProven ability to effectively manage, report on and communicate service provider performance and delivery quality.Advanced analytical skills, with the ability to analyze complex data and situations, learn quickly and create options, recommendations and action plans.Strong facilitation skills, including the ability to resolve issues and build consensus among groups of diverse stakeholders.Experience in independently defining, developing, managing and reporting on vendor processes and metrics.Ability to accomplish results through others by establishing relationships, effective controls and monitoring processesNormally to be proficient in the competencies listed aboveHealthcare Services Vendor Manager I would have a/an Bachelor''s Degree in Nursing, Health Care Administration, or related field, 5-7 years'' experience with an area of focus (e.g. care management or utilization management) in healthcare insurance operations and/or managing leading complete projects/programs and working with third party service providers or equivalent combination of education and experience. Masters preferred. Previous leadership experience preferred.

Created: 2021-11-29