Humana · 1 day ago
Vendor Management Lead
United States
Full-time
Remote
Mid, Senior Level
$95K/yr - $130K/yr
5+ years expHumana Inc. is committed to putting health first and is seeking a Vendor Management Lead to oversee vendor management operations. This role involves directing a team of RN professionals, fostering vendor relationships, and resolving clinical and operational issues to ensure quality care and compliance.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
Provide strategic leadership and guidance to the Senior Vendor Management Professional (RN) team, ensuring effective execution of vendor management initiatives in accordance with Humana’s policies and regulatory requirements
Oversee and optimize vendor relationships, including performance monitoring, compliance management, and the resolution of complex operational and clinical issues
Facilitate collaboration between Humana, vendor partners, and providers, ensuring clear communication channels and the successful implementation of market-based strategies
Support the review of clinical authorizations and ensure consistency with established guidelines for various levels of care, leveraging clinical expertise and best practices
Identify systemic gaps and process improvement opportunities across vendor partnerships, developing and implementing action plans to close gaps and enhance service delivery
Analyze market trends, operational data, and vendor performance metrics to inform decision-making and drive continuous quality improvement
Ensure adherence to privacy, security, and enterprise information protection protocols, escalating issues as appropriate and maintaining compliance with internal procedures
Mentor and develop team members, fostering a culture of accountability, collaboration, and professional growth
Participate in strategic planning, vendor selection, and contract negotiations as needed, ensuring alignment with organizational objectives and clinical standards
Represent the vendor management function in cross-functional meetings, audits, and enterprise initiatives
Qualification
Required
Active and unrestricted Compact license (RN) license required
Prior experience in a healthcare or insurance setting
5 + years of Utilization Management experience
3 + years of vendor management and/or process or project management experience
Demonstrated ability to define and track KPIs and/or service level agreement metrics and other measurable success criteria
Proven verbal and written communication skills with the ability to interact effectively across all organizational levels
Ability to break down complex problems into actionable steps
Demonstrated critical thinking and analytical problem-solving skills
Exceptional relationship management skills
Demonstrates accuracy and thoroughness, identifies process improvements
Proficient in Microsoft Office applications including Word, Excel and PowerPoint
Advanced facilitation skills with experience leading cross-functional discussions
Preferred
Master's Degree
Knowledge of claims processes
Knowledge of Stars and HEDIS
Knowledge of clinical quality benchmarks and reporting requirements for value base providers
Certification with Six Sigma and/or the Project Management Institute
Knowledge of Medicare Advantage
Grievance and Appeals experience
Benefits
Medical
Dental and vision benefits
401(k) retirement savings plan
Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Cynthia Zipperle
Vice President, Chief Accounting Officer and Controller
Recent News
2026-02-04
HealthCareIT News
2026-02-04
HealthCareIT News
2026-02-04
Company data provided by crunchbase