Accountable for all aspects of moderately complex, high visibility medical management vendors. Requires functional integration company wide. The Clinical Vendor Manager is responsible for the overall management of assigned medical management vendors including but limited to: Plan liaison, ongoing communication with vendor, delegation oversight, oversight of delegation and managerial reporting requirements, problem solving operational issues with input from Plan subject matter experts, implementing new products with vendor and implementing new medical management vendors under the guidance of the Senior Clinical Vendor Manager.
manages clinical vendor and monitors return on investment in collaboration with Director of Outsourced Managed Care Analysis
responsible for oversight of delegation of NCQA related responsibilities
manages the activities of complex work processes to achieve program goals including but not limited to ensuring that the vendor is meeting contractual, regulatory and accreditation requirements
collaborates with legal and chief medical officer (CMO) for initial contract if applicable
collaborates with legal and chief medical officer (CMO) for modifications or renewals of contract
managing, tracking and resolving day to day issues
liaison to and from the vendor
manages the contract and reconciling administrative invoices
monitor network adequacy, if applicable
works with the Senior Clinical Vendor Manager to review available data and identify trends that may need to be addressed
leads ongoing meetings (e.g. Clinical, Operations) with Plan staff and vendor staff
reviews reports with input from Plan subject matter experts as needed
point person for collecting regulatory, management and delegation oversight reports; includes ensuring appropriate Plan staff have reviewed and signed off on reports
Drafts, contributes to and/or coordinates with vendor responses for assigned Request for Proposal questions.
Capable of managing 10-15 FTEs on project teams
Bachelor’s degree in Health Care Administration, Public Health, Nursing, or related field
Master’s degree in a related field preferred.
3+ years healthcare/managed care experience (specifically UM, quality and/or project/program management)
Experience with Medicaid recipients and community services.
Proficiency with Microsoft Excel, Visio and other data entry processing applications
Competencies, Skills, and Attributes:
Detail oriented, excellent proof reading and editing skills
Demonstrated ability in facilitating cross-functional teams
Demonstrated ability to work independently and manage multiple projects simultaneously.
Excellent organizational and project management skills
Demonstrated commitment to excellent customer service
Understands services to diverse member populations
Effective collaborative and proven process improvement skills
Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts
Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting
Strong analytical and problem solving skills
Working Conditions and Physical Effort:
Ability to work in a fast paced environment
Occasional travel may be required
Boston Medical Center HealthNet Plan - 11 months ago