The Senior Vendor Manager is responsible for all aspects of clinical and non-clinical vendor management, excluding the Managed Behavioral Health Organization (MBHO) and the Pharmacy Benefit Manager (PBM), from due diligence to ongoing day to day management of complex and high visibility vendors. The Senior Vendor Manager serves as the internal and external vendor subject matter expert and the first point of escalation for any vendor related issues. Senior Vendor Manager provides information to executive level staff for budget development and maintenance related to vendors. Responsible for high level knowledge of all vendors managed by the vendor management team, activities and performances. Accountable for ensuring vendor compliance with contractual, regulatory and accreditation requirements involving significant cross-functional interface, complexity, risk and/or cost. Evaluates the cost and feasibility of options to resolve program issues and makes recommendations that meet overall business objectives. Consults to program operational staff and management at all levels regarding complex issues that arise on a day-to day basis as well as at a strategic level. Accountable for vendors achieving targeted cost savings and meeting performance guarantees. Responsible for RFP development and management as well as vendor contract negotiations and vendor re-procurement.

Key Functions/Responsibilities:

Overall

• Key internal and external vendor contact and subject matter expert
• First point of escalation within Vendor Management Team for any complex, high profile or high cost issue needing resolution
• Accountable for timely resolution of escalated issues (e.g. complaints, inquiries) raised by external parties (e.g. members, providers, MassHealth, CMS, Connector, NH DHHS, trade associations, Boston Medical Center Chief Executive Officer) and sharing resolution with Public Partnerships and/or CMO
• Provides ongoing mentoring and training to Vendor Management staff and develops associated training materials and resource materials
• Accountable for strategizing with Plan senior leadership, Chief Clinical Officer, Finance and vendors to identify ongoing cost savings opportunities
• Accountable for managing RFPs and writing timely responses for vendors to RFP questions

Due Diligence through Vendor Selection

• Lead benchmark research to identify potential vendors based on industry research
• Point person to coordinate exchange of information, documentation and data via Request for Information to facilitate vendor selection
• Synthesize and present key findings and proposals of potential vendors to stakeholders
• Coordinate onsite vendor presentations and evaluation of each vendor
• Present summary of information and presentations to stakeholders to select vendor
• Document due diligence leading to vendor selection

Implementation of New Line of Business or New Vendor

• Conducts pre-delegation assessment of any delegated NCQA related activities if applicable
• Collaborates with Accreditation Manager to write delegation agreement and reporting exhibit for delegated NCQA related activities.
• Negotiates initial contract in collaboration with legal and finance, involving key stakeholders if needed
• Reviews and revises related member handbook or evidence of coverage language
• Reviews and revises related provider manual
• Reviews vendor policies and procedures as applicable
• Reviews and revises vendor provider manual if applicable
• Facilitates identification of all implementation business requirements and interdependencies
• Completes documentation required by regulatory agencies (e.g. MassHealth Material Subcontractor Checklist)
• Develops and delivers training to internal and external parties as needed

Ongoing Management of Vendors

• Accountable for monitoring and optimizing return on investment (ROI) working closely with the Finance department
• Chairs or co-chairs vendor oversight committee
• Manages the activities of complex work processes to achieve program goals including but not limited to ensuring that the vendor is meeting contractual, regulatory and accreditation requirements
• Manages, tracks and resolves day to day issues
• Renegotiates contract modifications or renewals in collaboration with legal and finance
• Recommends program or contractual changes to senior management to improve vendor performance or increase cost savings
• Develops corrective action plan with vendor for suboptimal performance and monitors results
• Manages the Plan’s contract with the vendor and reconciles administrative billing
• Monitors network adequacy, identifies potential risks and escalates appropriately if applicable
• Leads development/revision of reports in collaboration with other areas of the company including but not limited to business intelligence, finance and claims.
• Reviews available data and metrics to identify trends that may need to be addressed
• Leads ongoing meetings with Plan staff and vendor staff
• Point person for collecting regulatory, management and delegation oversight reports; includes ensuring appropriate Plan staff have reviewed and signed off on reports
• Ongoing delegation oversight of delegated NCQA related activities to ensure accreditation and contractual requirements are continuously met
• Other projects and duties as assigned

Supervision Exercised: Capable of managing 10-20 FTEs on project teams

Qualifications:

Education Required:

• Bachelor's Degree or the equivalent combination of training and experience, plus 4-7 years related experience.
• Master's degree in a related field preferred.

Experience Required:

• 7+ years healthcare/managed care experience in vendor management, project/program management
• Working knowledge of regulations impacting vendor relationships within the managed care industry (e.g. CMS, NCQA, URAC, MH, DOI, DHHS)
• Experience with Medicaid and Medicare preferred

Competencies, Skills, and Attributes:

• Detail oriented, excellent proof reading and editing skills
• Demonstrated ability in facilitating cross-functional teams
• Demonstrated ability to work independently and manage multiple projects simultaneously.
• Demonstrated ability to analyze, compile, format, and present data to a variety of individuals at all levels of the organization including administrative staff, physicians, and committees
• Excellent negotiation, organizational and project/program management skills
• Demonstrated commitment to excellent customer service
• Understands services to diverse member populations
• Proficiency with Microsoft Excel, Visio and Access and other data entry processing applications
• Effective collaborative and proven process improvement skills
• Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external contacts
• Strong negotiation skills
• Demonstrated ability to successfully plan, organize, implement and manage projects within a health care setting
• Strong analytical and problem solving skills

*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.