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Senior Manager, Vendor Performance

Company

CareSource
Address , Remote
Employment type FULL_TIME
Salary $87,000 - $152,300 a year
Expires 2023-07-30
Posted at 11 months ago
Job Description
Job Summary:
The Senior Manager, Vendor Performance is responsible for developing and leading a team of vendor oversight managers. Responsibilities include establishing and maintaining a model of vendor performance that identifies areas of potential exposure for regulatory adherence for delegated vendors, tracks, aggregates and analyzes trends for KPIs within spend categories for delegated and non-delegated vendors, develops and aligns vendor oversight and performance strategies with CareSource goals and objectives, and executes program ensuring consistency and vendor performance.
Essential Functions:
  • Assess, interpret, and incorporate new and revised regulatory, government contract and RFP requirements into service levels for vendor and delegated agreements; remain current in federal/state laws and regulations, industry standards and best practices around delegation oversight
  • Oversee and manage the core oversight and performance functions such as Pre-Delegation, Contracting, Ongoing Monitoring, Vendor Oversight and Performance Strategy, Annual Audits, Corrective Action Plans and Regulatory Changes
  • Partner with Strategic Sourcing to obtain timely data as it pertains to delegated and non-delegated vendor contract performance; track and trend key performance indicators within business spend categories to ensure adherence to regulatory requirements and CareSource contractual terms
  • Report potential risks, non-compliance or alleged violations to CareSource leadership
  • Partner with Compliance as a member of all relevant compliance committees and reports for external agencies which includes providing data and feedback for any external audits regarding delegated entities
  • Maintain awareness of operational risks faced by the business from vendor failure/poor performance and work with Strategic Sourcing/Legal/Business to mitigate any losses through vendor oversight
  • Report key statistics and trends of core oversight functions, identifying risk mitigation and performance improvement opportunities to the Delegation Oversight and Corporate Compliance Committees, Quality Committees, Corporate Compliance, and Credentialing Oversight Committee
  • Perform data analytics and reporting activities; provide and maintain oversight and performance reporting mechanisms, and track and report outcomes from vendor and provider management activities, collect, organize, and distribute reports and documents and recommend enhancements to reporting and audit tools
  • Manage, mentor, and develop staff
  • Perform and develop the training plan to facilitate the effective application and awareness of delegated and non-delegated vendor performance management
  • Conduct performance management activities for direct reports including performance appraisals and discipline as appropriate; provide feedback on deliverables to staff on a timely basis
  • Manage the coordination of documentation submittals and participate in federal and state contract audits, regulatory audits and accreditation reviews
  • Provide guidance to the business, legal, strategic sourcing, regulatory, compliance and other stakeholders to ensure requirements of vendor and delegated agreements are fully understood
  • Partner with Business Units and internal support functions to help ensure that all delegated and non-delegated vendor performance monitoring is executed
  • Ensure staff, leadership, vendor and provider training on regulatory, government contracts and accreditation requirements are being met
  • Partner with Business Units and Strategic Sourcing to develop and implement strategies around delegated and non-delegated vendor performance; assessing the market within and outside spend categories to identify best in class KPIs and ensure inclusion in contracts
  • Maintain and administer vendor performance database and/or platform
  • Partner with Strategic Sourcing to provide information on Key Performance Indicators within spend categories to ensure alignment to key business and strategic goals of CareSource.
  • Serve as the subject matter expert in interpreting requirements, determining delegation and Vendor/Provider oversight of delegated and non-delegated entities
  • Perform any other job duties as requested
  • Partner with Strategic Sourcing to develop and standardize key performance indicators to drive a best in class vendor performance operating model
  • Chair and/or serve on designated internal committees to represent vendor and provider oversight requirements
  • Support accreditation initiatives, including URAC and NCQA
  • Stay informed about the latest developments in delegation oversight field, including new products and services, through relevant subject matter resources, professional associations, industry conferences, training seminars, and other information sources
Education and Experience:
  • Bachelor of Science/Arts degree in Business or in a related medical or business field or equivalent years of relevant work experience is required
  • Minimum of three (3) years prior management experience is required
  • Minimum of five (5) years in a Managed Care Organization; or other healthcare related field is preferred
  • Minimum of eight (8) years of contracting, vendor oversight, strategic sourcing, compliance, account management, process improvement, quality assurance, internal audit or equivalent experience is required
  • Master of Health Administration, Business, Management, related Health or Mental Health or J.D. in Law is preferred
Competencies, Knowledge and Skills:
  • Comprehensive knowledge of applicable concepts and methodologies such as continuous quality improvement and auditing experience
  • Proven success in developing and implementing new practices and controls (with specific improvements)
  • Working knowledge of health plan environment is preferred
  • Experience in a high-growth business environment
  • Ability to develop, prioritize and accomplish goals
  • Advanced capabilities in Microsoft Word, Excel and PowerPoint
  • Ability to work independently and within a team environment
  • Leadership/management skills
  • Strong interpersonal skills and high level of professionalism
  • Effective active listening and critical thinking skills
  • Strong communication skills (both written and verbal)
  • Strong project management skills with ability to handle multiple projects within time constraints
  • Effective problem solving skills with attention to detail
  • Display a customer service, member-focused orientation
  • Strong analytical and statistical skills and attention to detail
  • Knowledge of and application of regulatory compliance (Medicare, Medicaid, Health Exchange and/or Duals), quality measures (HEDIS/ STARS) and/or accreditation standards (NCQA/ URAC)
  • Knowledge of contracting, standards or controls management, preferably from a Managed Care Organization
  • Skilled in collaborative management of professional staff
  • Ability to work in a fast-past environment and reprioritize
Working Conditions:
  • General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$87,000.00 - $152,300.00
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
  • Develop Self and Others
  • Cultivate Partnerships
  • Pursue Personal Excellence
  • Drive Execution
  • Understand the Business
  • Influence Others
  • Create an Inclusive Environment

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer, including disability and veteran status. We are committed to a diverse and inclusive work environment.