Description

• Job Responsibilities:

· Manage vendor utilization including work flows for coordinating services with the Health Plan

· Analyze vendor data and complete required reports for the health plan, Corporate and state

· Create and manage vendor scorecard and associated ratings/correction plans

· Perform as a key account manager for the Health Plan to coordinate with high priority providers and vendors

· Coordinate with Corporate Vendor Management team regarding vendor expectations, performance and procedures

· Coordinate with various cross-functional departments to educate and communicate expectations, performance and procedures to vendors

· Conduct monthly meetings and document discussions, issues, attendees, action items

· Research and resolve claim disputes with vendor, member or provider issues and route to appropriate person(s) for resolution

· Ensure operation integrity, including compliance with all policies and procedures for the Health Plan including adherence to state contract and guidelines

· Request and/or assist in the development of correction action plans for standards that are not met by the vendor

Requirements

Education/Experience:

• Bachelor's degree in Business Administration, Public Administration or related field or equivalent experience.
• 4 years of healthcare management experience, preferably in vendor managed care or the health insurance field.
• Experience with reporting and analyzing data preferred. Strong Excel skills and working with a variety of software data programs preferred. Project management experience a plus.