PA Health & Wellness · 1 day ago
Vendor Performance Manager
United States
Full-time
Remote
Senior Level
$70K/yr - $126K/yr
5+ years expPA Health & Wellness is a national organization focused on transforming community health for its members. The Vendor Performance Manager will manage relationships with third-party Delegation partners, ensuring compliance, performance management, and effective communication between vendors and internal departments.
FitnessHealth CareWellness
Responsibilities
Serve as a key account manager for assigned vendors, ensuring effective communication, compliance with contracts, and optimal performance
Manage vendor utilization including work flows for coordinating services with the Health Plan and/or Operations Departments
Provide and share monthly SLA performance dashboards and/or reporting with Delegated entity and address issues in performance of assigned SLA’s
Request and/or assist in the development of correction action plans for standards that are not met by the vendor and implement correction action plans when necessary
Track, analyze, and report on vendor performance and opportunities for improvement
Create and manage vendor scorecard and associated ratings/correction plans
Coordinate with Medical Management, Member Services, and Provider Services to educate and communicate expectations, performance and procedures to vendors
Schedule and conduct monthly meetings with Delegated entities and document discussions, issues, attendees, and action items
Research and resolve claim disputes with vendor, member or provider issues and route to appropriate person(s) for resolution
Work closely with internal stakeholders to ensure vendors meet business needs and objectives
Receive and respond to provider related database information requests and concerns
Ensure operation integrity, including compliance with all policies and procedures for including adherence to state contract and guidelines
Contribute to special projects and other planning initiatives that involve oversight of the Delegated Care Management entities
Performs other duties as assigned
Complies with all policies and standards
Qualification
Required
Bachelor's Degree Business Administration, Public Administration or related field or equivalent experience
5+ years supporting working with Primary Care Providers
Account Management experience working in Healthcare or related field
Ability to present to executive-level teams at the delegated entities
Preferred
Experience working in call center customer service settings
Understanding of how a call center operates
Experience in Medicare, specifically supporting Medicare members
Benefits
Competitive pay
Health insurance
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Company
PA Health & Wellness
Established to deliver quality healthcare in the state of Pennsylvania through local, regional and community-based resources, PA Health & Wellness is a Managed Care Organization and subsidiary of Centene Corporation (Centene).
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Justin Davis
President and Chief Executive Officer
Recent News
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