Healthfirst
Job Description
Manager, Dental Vendor Performance
at
Healthfirst . Reporting to the Director, Delegated Vendors, this role will lead the oversight responsibilities of delegated vendor functions. The Manager will serve as a liaison between the vendor and Healthfirst, supporting vendor management processes and programs to ensure contractual and regulatory requirements are met.
Responsibilities
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.
Resolve all issues related to ancillary delegated relationships.
Serve as liaison between vendors and cross‑functional internal departments (Network, Claims, IT/IS, Medical Management, Credentialing, etc.) to ensure timely and quality deliverables.
Act as liaison for CMS/NYSDOH audits, member complaints, and other member‑satisfaction initiatives.
Lead contract negotiations and renewals.
Track and trend performance guarantees and key performance indicators related to contractual penalties or incentives.
Provide performance data on vendors to the Director on a monthly/quarterly basis.
Maintain effective working relationships with delegated vendors and internal stakeholders to meet performance metrics, identify improvement opportunities, mitigate risk, and eliminate barriers to corrective action plans (CAPs).
Participate in Vendor Oversight Committee, Joint Operating Committees, and other ad‑hoc meetings as directed.
Analyze, track, and follow up on the timely resolution of errors and issues arising from vendor processes, escalating unresolved inquiries to the Manager.
Maintain and update an issue tracking log for delegated vendors.
Review and validate audit templates (SDOH, CMS, etc.).
Coordinate projects and vendor configurations, develop project plans, and monitor deliverables.
Lead implementation strategies to improve vendor engagement for HEDIS and STARS Quality Initiatives.
Participate in the RFP process from initiation through contracting and onboarding of new delegates.
Analyze, update, and modify procedures to continually improve operations.
Monitor vendor corrective action plans (CAPs) and implement as necessary.
Perform IT user acceptance testing (UAT) for enrollment files, claims reporting, encounter data files, and other IT changes impacting delegates.
Monitor electronic feeds and UAT to ensure accurate receipt/transmission of data files.
Identify opportunities for process improvement and efficiency.
Minimum Qualifications
Bachelor’s degree from an accredited institution or equivalent work experience.
Experience in delegated vendor management oversight.
Ability to communicate and influence 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.
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at
Healthfirst . Reporting to the Director, Delegated Vendors, this role will lead the oversight responsibilities of delegated vendor functions. The Manager will serve as a liaison between the vendor and Healthfirst, supporting vendor management processes and programs to ensure contractual and regulatory requirements are met.
Responsibilities
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.
Resolve all issues related to ancillary delegated relationships.
Serve as liaison between vendors and cross‑functional internal departments (Network, Claims, IT/IS, Medical Management, Credentialing, etc.) to ensure timely and quality deliverables.
Act as liaison for CMS/NYSDOH audits, member complaints, and other member‑satisfaction initiatives.
Lead contract negotiations and renewals.
Track and trend performance guarantees and key performance indicators related to contractual penalties or incentives.
Provide performance data on vendors to the Director on a monthly/quarterly basis.
Maintain effective working relationships with delegated vendors and internal stakeholders to meet performance metrics, identify improvement opportunities, mitigate risk, and eliminate barriers to corrective action plans (CAPs).
Participate in Vendor Oversight Committee, Joint Operating Committees, and other ad‑hoc meetings as directed.
Analyze, track, and follow up on the timely resolution of errors and issues arising from vendor processes, escalating unresolved inquiries to the Manager.
Maintain and update an issue tracking log for delegated vendors.
Review and validate audit templates (SDOH, CMS, etc.).
Coordinate projects and vendor configurations, develop project plans, and monitor deliverables.
Lead implementation strategies to improve vendor engagement for HEDIS and STARS Quality Initiatives.
Participate in the RFP process from initiation through contracting and onboarding of new delegates.
Analyze, update, and modify procedures to continually improve operations.
Monitor vendor corrective action plans (CAPs) and implement as necessary.
Perform IT user acceptance testing (UAT) for enrollment files, claims reporting, encounter data files, and other IT changes impacting delegates.
Monitor electronic feeds and UAT to ensure accurate receipt/transmission of data files.
Identify opportunities for process improvement and efficiency.
Minimum Qualifications
Bachelor’s degree from an accredited institution or equivalent work experience.
Experience in delegated vendor management oversight.
Ability to communicate and influence 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.
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