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General Information

Req ID
R021251
State
New York
Work Type
Hybrid

Description and Requirements

Reporting to the Director, Delegated Vendors, the Manager, Ancillary Delegated Vendors will lead the oversight responsibilities of their vendor delegated functions. This position will serve as a liaison between the vendor and Healthfirst. They will support the vendor management processes and programs at Healthfirst to ensure that contractual and regulatory requirements are met.

Job Description

  • Oversee and monitor delegated vendor and internal business owner relationships to ensure compliance, optimal delegate performance and achievement of business goals according to Service Level Standards and other contractual requirements.
  • Resolving all issues related to ancillary delegated relationships.
  • Serve as Liaison between vendors and cross-functional internal departments and teams to ensure timely and quality deliverables from vendors and internal departments such as Network, Claims, IT//IS, Medical Management, Credentialing and other areas as needed.
  • Acts as a liaison between other departments and delegates related to CMS//NYSDOH audits, member complaints, etc. Collaborates with other departments within Healthfirst to improve all aspects of a delegated functions including member satisfaction
  • Responsible for contract negotiations and renewals
  • Track and trend Performance Guarantee and key performance indicator related to contractual penalties or incentives
  • Provide Director with performance data on vendors based on contractual requirements and Service Level Standards on a monthly//quarterly basis.
  • Maintain effective working relationships with delegated 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).
  • Participate in Vendor Oversight Committee, Joint Operating Committees and other ad hoc meetings//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 to Manager.
  • Maintain and update an Issue Tracking Log for delegated vendors
  • Perform review of SDOH, CMS and other internal//external audit templates to validate data
  • Serve as a project coordinator  to lead projects//vendor configurations as assigned, develop project plans, support workgroup and monitor vendor and internal deliverables
  • Assist and lead implementation strategies to improve delegated vendor engagement strategies for HEDIS and STARS Quality Initiatives.
  • Participate in Request for Proposal (RFP) process from initiation, contracting and onboarding for potential new delegates
  • Analyze, update, and modify procedures and processes to continually improve operations.
  • Monitor and report instances of vendor Corrective Action Plans (CAPs) implement CAPs as necessary.
  • Perform IT User acceptance testing (UAT) assessments related to enrollment files, claims reporting, encounter data files, accumulator files and as needed reviews for IT changes which impact the delegate
  • Monitor electronic feeds and User acceptance testing (UAT) to ensure receipt//transmit data files to delegates
  • Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows


Minimum Qualifications:

  • Bachelor's degree from an accredited institution or equivalent work experience

  • Delegated vendor management oversight work experience

  • Experience communicating and influencing impact and progress to senior leadership

  • Domestic and international travel may be required


Preferred Qualifications:

  • Expertise in healthcare operations

  • Management experience in an operational department within the healthcare industry 

  • Experience developing strategy and processes for a department or function


Compliance & Regulatory Responsibilities: Noted above

License//Certification: N//A

Hiring Range*:

  • Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430

  • All Other Locations (within approved locations): $88,700 - $131,920

    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. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services,  LLC.