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Medica · 2 hours ago

Clinical Vendor Program Manager IV

Madison, WI

Full-time

Hybrid

Mid, Senior Level

$89K/yr - $133K/yr

7+ years exp

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. The Clinical Vendor Program Manager role is responsible for vendor oversight and delivery of a delegated Utilization Management program, working closely with the Clinical Vendor Oversight Manager to ensure compliance and drive performance to meet Medica's mission and desired outcomes.

Health CareMedical

No H1B

Responsibilities

Act as the main point of contact for the vendor relationship to support a delegated clinical program and affordability initiative

Monitor vendor adherence to contractual terms, maintain service level agreement (SLA) documentation and budget management

Identify opportunities within the program and implement corrective action and remediation plans when necessary

Partner with Clinical Regulatory Oversight Program Manager to maintain regulatory compliance and deliverables

Ensure timely submission of reports and deliverables as outlined in Statements of Work (SOW)

Manage cross-functional relationships between IT and Business Partners to include but not limited to: Provider Network, Internal Utilization Management, Provider Data and Eligibility Teams, Claims, Customer Service and Account Management to support program success

Oversee affordability measures and outcome monitoring

Drive regular meetings with vendors and internal stakeholders to ensure program success

Facilitate complex conversations with vendors to achieve Medica's desired outcomes

Provide updates to leadership on vendor performance, risks, and mitigation strategies

Qualification

Vendor managementClinical delegated oversightMicrosoft OfficeProgram managementQuality improvementCommunicationLeadership

Required

Bachelor's degree or equivalent experience in related field

7+ years of related experience beyond degree

Computer proficiencies including Microsoft Office (Word, Excel, Access, Outlook, Visio, OneNote, etc.) and experience with others

Program functions (workflow, eligibility, claims, etc.)

Ability to lead and be a good role model, influence change, shape and initiate work with colleagues across the organization and external (care systems, community collaborations, and vendors) to achieve department goals

Ability to provide leadership based on teamwork, commitment & creative linkages with organizational business units, external vendors and care system representatives

Excellent written and verbal communication skills with all levels of the organization

Managing/Delegating/Measuring Work: Ability to develop appropriate objectives, accountabilities and measures. Ability to monitor and report progress; identify and address barriers

Quality Focus: Commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques

Experience setting expectations and direction for delivery by the team