Lead Vendor Management Specialist

Join our compassionate community and help us prioritize health! The Lead Vendor Management Specialist is essential in overseeing vendor management operations at a strategic level, ensuring compliance with clinical and operational standards aligned with Humana's mission. In this role, you will lead a team of experienced RN professionals, cultivate strong relationships with vendors and providers, and adeptly navigate clinical and operational challenges to support superior quality care. The Lead Vendor Management Specialist (RN) will play a pivotal role in guiding vendor management functions, tactically bridging Humana's business and clinical operations with our vendor partners and providers. You will provide visionary leadership and support to a team of Senior Vendor Management Professionals (RN), ensuring effective resolution of issues, identification of gaps, and optimization of processes to elevate quality care and operational excellence. This position also involves forming strategic partnerships to align with Institutional Special Needs Plan providers and overseeing the optimization of SNF provider networks from a clinical viewpoint. You will collaborate with Provider Engagement to track outcomes related to Value-Based and Delegated Services Providers. Key Responsibilities: Deliver strategic direction and leadership to the Senior Vendor Management Professional (RN) team, ensuring execution of vendor management initiatives aligns with Humana's policies and regulatory requirements. Enhance and manage vendor relationships, focusing on performance monitoring, compliance, and resolving complicated operational and clinical issues. Drive collaboration between Humana, vendor partners, and providers, establishing clear communication and ensuring successful adoption of market-based strategies. Review clinical authorizations to confirm compliance with established guidelines for various levels of care, utilizing your clinical expertise and best practices. Spot opportunities for system improvements and develop actionable plans to optimize service delivery across vendor partnerships. Evaluate market trends, operational metrics, and vendor performance to inform strategic decision-making and sustain quality improvement. Uphold compliance with privacy, security, and information protocols while escalating necessary concerns and adhering to internal procedures. Mentor and develop team members, fostering a culture of accountability and professional development. Engage in strategic planning, vendor selection, and contract negotiations to align with organizational goals and clinical standards. Represent the vendor management function in cross-functional meetings, audits, and enterprise initiatives. Utilize your skills to drive impactful change! Required Qualifications: Active and unrestricted Compact license (RN) required Experience in a healthcare or insurance setting 5+ years of Utilization Management experience 3+ years of vendor management or project management experience Proven ability to define and track KPIs and service level agreement metrics Excellent verbal and written communication skills with the ability to engage across all organization levels Ability to deconstruct complex problems into actionable solutions Strong critical thinking and analytical problem-solving capabilities Exceptional relationship management skills A dedication to accuracy and thoroughness, with an eye for process improvements Proficiency in Microsoft Office applications including Word, Excel, and PowerPoint Advanced facilitation skills with experience in leading cross-functional discussions Preferred Qualifications: Master's Degree Understanding of claims processes Familiarity with Stars and HEDIS metrics Knowledge of clinical quality benchmarks and reporting for value-based providers Certifications in Six Sigma and/or Project Management Institute Knowledge of Medicare Advantage principles Experience with Grievance and Appeals processes Additional Information: This position will require 5-15% travel within the market. Work-At-Home Requirements: Must have a high-speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25mbps download x 10mbps upload) is required. A dedicated workspace free of interruptions to protect member PHI / HIPAA information is also necessary. Interview Format: The hiring process will utilize an innovative technology called HireVue to assess relevant skills and experiences at your convenience. If selected, you will be invited to partake in a HireVue assessment that lasts approximately 15-20 minutes, and you'll receive feedback based on your responses. While this is primarily a remote position, occasional travel to Humana offices for training and meetings may be necessary. Scheduled Weekly Hours: 40 Pay Range: The compensation range reflects a good faith estimate of starting base pay for full-time employment, with potential adjustments based on geographic location and individual qualifications. The range is $94,900 - $130,500 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance. Description of Benefits: Humana offers competitive benefits that promote overall well-being including medical, dental, vision, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and more. Application Deadline: 02-20-2026 About Us: Humana Inc. (NYSE: HUM) is dedicated to prioritizing health for our teammates and the communities we serve, providing healthcare solutions that lead to improved quality of life for those we serve. Equal Opportunity Employer: Humana is an equal opportunity employer and does not discriminate based on various protected characteristics. We value diversity and implement affirmative action to ensure equal opportunities in employment.

Created: 2026-03-07