Director, Vendor Performance & Oversight(Preferred Experience in Managed Care & Vendor Management)

Job Summary:

The Director, Vendor Performance & Oversight is responsible for the overall strategy, implementation and day-to-day operations of the Vendor Performance & Oversight management team. Responsible for ensuring that all delegated and non-delegated vendors meet contractual obligations, regulatory requirements, and performance standards. The Director will establish tiering criteria for vendors, oversee compliance, and ensure proper risk assessment of vendors to support the organization's strategic goals.

Essential Functions:

• Responsible for managing the life cycle for delegated and non-delegated vendors and delegated providers, internal and external communications, program oversight and performance tracking
• Perform pre-delegation assessments, conduct annual audits, and oversee the performance of delegated vendors using scorecards.
• Work with Compliance, Regulatory, Legal, Data Security, Enterprise Risk Management, and Internal Audit to establish and manage enterprise-wide delegated vendor and provider risk and oversight policy and develop procedures
• Serve as the primary representative for regulatory reporting submissions related to delegated entities at both state and federal levels.
• Act as a liaison for internal and external audits concerning delegates, contracts, and policies & procedures.
• Track and ensure that regulatory requirements for vendors are incorporated into contracting and oversight processes.
• Prepare and submit regulatory reports for all delegated entities, focusing on oversight-specific requirements.
• Develop and maintain policies and procedures related to vendor oversight.
• Determine delegation criteria and make recommendations for vendor delegation.
• Expand vendor auditing processes, including focused audits and onsite evaluations for delegated vendors.
• Establish tiering criteria for vendors and manage oversight activities to align with the designated tiering level.
• Manage vendor non-compliance penalties, oversee annual attestation of compliance, and ensure prohibited affiliation attestations for delegated and high-risk vendors.
• Monitor ongoing vendor performance to ensure compliance with contract obligations and achievement of performance standards.
• Conduct quarterly or bi-annual business reviews to assess vendor performance and identify areas for improvement.
• Manager the vendor risk process to ensure that new and existing vendors are financially viable and maintain appropriate coverage in accordance with regulatory and CareSource requirements.
• Conduct risk assessments and implement strategies to mitigate vendor-related risks.
• Provide leadership and professional development for team members, fostering a culture of excellence
• Performs any other job related duties as requested.

Education and Experience:

• Bachelor's degree required
• Master's in Business Administration (MBA) or related field preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Seven (7) years of experience in managing vendor/provider relationships within a highly regulated industry required
• Five (5) years management/leadership experience required
• Experience in an HMO or managed care environment required

Competencies, Knowledge and Skills:

• Advanced proficiency level with Microsoft Office including Outlook, Word, Excel and PowerPoint Business related software systems expertise is preferred
• Knowledge in Medicaid/Medicare Programs and CMS, NCQA regulations
• Understanding of government regulation and accreditation requirements and used to managing vendor relationships to ensure compliance
• Solid understanding of managed care, vendor agreements and the delegation process
• Strong organizational skills, detail oriented, and sound decision making skills required; exceptional follow-through abilities to track all outstanding tasks and coordinate with assigned owners to ensure tasks are completed timely
• Working knowledge of health plan functions including: operations, marketing/sales, compliance, information systems, data analysis and clinical is preferred
• Working knowledge of regulations affecting vendor relationships within Managed Care (CMS, NCQA, URAC, etc.)
• Excellent writing and communication skills; able to translate technical concepts into layperson’s terms and interface with upper-level management including Legal Counsel and Corporate Compliance
• Ability to interact with all levels of leadership, influence change in corporate understanding and adoption of vendor management concepts, and lead cross-functional teams and initiatives
• Analytical with the ability to handle responsibilities that are complex and distill and manage data to achieve desired outcomes
• Experience preparing presentations and speaking before individuals and groups, vendors, regulatory agencies, community leaders and upper management who may pose challenging or difficult questions

Licensure and Certification:

• Certified HealthCare Auditor (CHA); Certified Internal Auditor (CIA); Certified Healthcare Compliance (CHC) or other related certification preferred preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Up to 15% (Occasional) travel based on the needs of the department may be required

Compensation Range:

$132,900.00 - $232,700.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

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. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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