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Monitors and maintains vendor relationships across multiple markets and products. Maintains long-term performance oversight functions that enable compliant, cost-effective, delivery of medical services. Resolves vendor issues and recommends solutions analogous to best practices. Monitors and maintains contractual vendor payment and assists in implementation activities.
Monitors assigned delegated vendor relationships with the responsibility for ensuring contractual requirements and performance service levels of delegated functions are adhered to in a compliant manner.
Drives compliant resolution of all vendor issues and including vendor communications and reporting.
Tracks and resolves vendor FFS payment and other issues by working with internal departments, vendors and finance
Conducts quarterly JOC meetings with internal partners and vendors
Develops and maintains approved vendor document library
Interfaces with management (corporate and market level) and WellCare matrix partners in order to ensure contractual obligations are achieved.
Assist managers with implementation, escalations and follow up items as needed
Maintains highly effective working relationships with vendors and internal matrix partners in order to improve vendor performance
Develop step actions, trainings and other documents to support department processes and education
Assist in the development and maintenance of various Corporate Ancillary policies and procedures effecting Vendor Management.
Manage projects including implementations for delegated functions as needed
Collaborates with functional areas to ensure vendors provide compliant day to day operations that bring quality and value to the total enterprise.
Works with internal parties and vendors set up processes to reduce frequency of FFS issues
Performs other duties as assigned.
Drives ongoing process improvement to deliver increasing vendor quality, compliance, and efficiency in all vendor related processes.
Required A Bachelor's Degree in a related field
Required or equivalent work experience 2 additional years of vendor management or oversight preferably with healthcare vendors
Required 2 years of experience in Handling service issues for members or providers
Required 3 years of experience in vendor management or oversight preferably with healthcare vendors
Required Other Demonstrated aptitude and experience for managing processes across functional teams
Required Other Solid understanding of managed care, vendor provider agreements and the delegation process
Preferred Other Medicare/Medicaid health plan experience
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated written communication skills
Intermediate Ability to influence internal and external constituents
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to effectively present information and respond to questions from peers and management
Intermediate Ability to work independently
Intermediate Ability to communicate and make recommendations to upper management
Intermediate Other Solid understanding of managed care, vendor provider agreements and the delegation process
Intermediate Other Ability to handle responsibilities that are complex with results that may have long-range implications
Intermediate Other Ability to remain calm under pressure
Licenses and Certifications: A license in one of the following is required: Technical Skills:
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel
Required Intermediate Microsoft PowerPoint
Required Intermediate Microsoft Outlook
Required Intermediate Healthcare Management Systems (Generic)