Healthfirst

The Vendor Relationship Manager is responsible for the day-to-day relationships between Healthfirst and its onshore and offshore delegated vendors which manifest into vendor adherence with Key Performance Indicators (KPIs), Service Level Agreements (SLAs) and vendor compliance and regulatory requirements

Duties & Responsibilities:

• Oversee and monitor clinical vendor and internal business owner relationships to ensure compliance, optimal clinical vendor performance and achievement of business goals according to Service Level Standards and other contractual requirements
• Assess and address risk and growth areas through the strategic management of vendor relationships
• Demonstrate self-reliance, independent thinking and decision making in leading clinical vendors or working across various Healthfirst teams
• Maintain effective working relationships with clinical vendors and internal business stakeholders to ensure performance metrics are met, identify opportunities for improvement, mitigate risk and eliminate barriers to correct Corrective Action Plans (CAPs)
• Serve as Liaison between clinical vendors and cross-functional internal departments and teams to ensure timely and quality deliverables from vendors and internal departments
• Collaborate with other departments within Healthfirst to improve all aspects of clinical vendor functions including performance metrics, member satisfaction and CMS/ NYS DOH audits
• Develop processes for member list review and for member engagement oversight
• Track and trend KPIs related to contractual penalties or incentives
• Participate in Vendor Performance Committee and other meetings or activities as directed
• Analyze, track and follow-up on the timely resolution of errors and issues that are a result of vendor processes; and as necessary escalate unresolved inquiries/complaints
• Perform review of NYS DOH, CMS and other internal/external audit templates to validate data
• Develop plans and processes and monitor both clinical vendor and internal deliverables
• Assist and lead implementation strategies to improve clinical vendor engagement strategies for HEDIS and STARS Quality Initiatives.
• Coordinate with IT to perform user acceptance testing (UAT) assessments related to enrollment files, claims reporting, encounter data files, accumulator files, etc. or as needed for other clinical vendor activities
• Analyze, update, and modify procedures and processes to continually improve operations
• Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows
• Participate in Request for Proposal (RFP) process from initiation, contracting and onboarding for potential new clinical vendors, as required
• Perform other duties as assigned or necessary  

Minimum Qualifications:

• Familiarity with health risk assessments (HRAs)
• Demonstrated strong organizational, analytical, and interpersonal skills with detail-oriented focus
• Experience with reviewing and manipulating large data files, and observing trends or outliers
• Demonstrated computer proficiency, including but not limited to, Microsoft Outlook and Microsoft Office Word and Excel
• Experience managing vendor relationships with complex vendors
• Digitally oriented
• Demonstrated ability at planning, organizing, and executing
• HS Diploma or GED from an accredited program

Preferred Qualifications: 

• Knowledge of health insurance/ healthcare/ managed care environment
• Experience with relationship/ account management
• Effective verbal and written communication skills
• Advanced data manipulation and reporting skills a plus (SAS, R, Excel, Qlikview, etc.)
• Bachelor's Degree or higher from an accredited institution

Compliance & Regulatory Responsibilities: Noted above

License/Certification: N/A

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $79,300 - $114,580

• All Other Locations (within approved locations): $69,800 - $103,870

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.