network and vendor operations manager
3 weeks ago
JOB DETAILS
Our client is seeking a Vendor and Provider Network Manager to play a key role in establishing oversight and management of vendor and provider network partnerships for their integrated care delivery startup. This individual will be responsible for building, scaling, and continuously improving vendor management and provider network functions, as well as supporting various key departments in KPI development and tracking for vendors. The ideal candidate will have a strong understanding of health plan, healthcare provider & vendor contracting and regulatory requirements, and be passionate about serving high-risk seniors and frail older adults.
- Hybrid role but must be based in Los Angeles
- Travel (mostly locally) up to 50% based on business needs
- On-Site up to 10 days a month
- Full Time Permanent Position i
- Direct Hire
- Competitive Salary + Bonus & Excellent Benefits
COMPENSATION & BENEFITS
- Competitve Salary
- Performance-Based Cash Bonus
- 401k with Employer match
- Your choice of 6 medical plans, with premium coverage of up to 80% for employees and 75% for all dependents
- Dental Insurance
- Vision Insurance
- Health Savings Account
- Flexible Spending Accounts (FSA)
- Short- and Long-term Disability coverages
- PTO starting at 20 days per year; plus 12 paid holidays per year, and 2 floating holidays per year
- One-time stipend towards setting up your home office (for remote or hybrid roles)
- Family friendly policies, including paid new parent leave
RESPONSIBILITIES
- Manage and provide third party oversight including attestation tracking, vendor governance, auditing oversight, risk management, credentialing and ensuring necessary vendor trainings are up to date
- Identify opportunities to build positive business relationships with potential providers by connecting within the community along with other leaders
- Develop contractual relationships with service providers, drafts contract agreements, and maintains provider network listings
- Partnership with Quality and Compliance team on the establishment of mock audits in preparation for future State and CMS audit readiness
- Support provider network administration, including managing our catalog of contracts, properly loading all contracts into required systems/vendors, and delivering new vendor/provider onboarding
- Support Operations, IT, Finance and other key departments with procurement, vendor management and tracking of various contract types
- Co-lead regular reviews with the Quality & Compliance Director Improvement Manager/Compliance Officer to coordinate quality assessment of providers including onsite visits of providers
- Ensures that applicable websites are monitored monthly and as needed for disciplinary summaries from the Board of Medical Examiners, as well as excluded providers from Medicare and Medicaid (OIG)
- Collaborate with the central and local owners of the vendor relationship and support in ongoing monitoring of vendor performance as needed
- Implement a regular standing meeting with key contract owners at the time of renewal to evaluate performance and contract continuance
- Develop structure for contract repository system to manage that all executed agreements with quality controls in place to ensure all contracts are up to date and tracked
- Collaborate with Quality and Health Plan Compliance teams as needed for any related Fraud, Waste & Abuse (FWA) tracking of vendors/providers
- Manage and provide oversight to selected other external vendors related to any of the functions listed above and more, ensuring quality and adherence to protocols
- Develop policies and procedures that meet applicable PACE program requirements
- Stay current on regulations and policies impacting the PACE program, health plan operations, and our compliance program and share that knowledge across the organization
- Assist the company in ad hoc special projects, including collaborations with external partners, vendor contracting, and other operating model decisions
- Continuously seek improvements to processes and systems across functions as the size and complexity of our business grows
- Communicate confidently and persuasively to all audiences, including external stakeholders
REQUIREMENTS
- 5+ years of related experience in a similar role and education concentration (e.g., certification, Bachelor's, or Master's) in a related field (e.g., business, legal, healthcare administration/MHA, etc.) preferred
- Experience in corporate health plan, venture-backed startups, private equity, investment banking, or other finance-focused roles in high-growth and entrepreneurial environments
- Passion and mission orientation for serving high-risk seniors and frail older adults
- Strong understanding of health plan, healthcare provider & vendor contracting and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization
- Thrives in a relatively undefined, "zero to one" environment – unafraid to "roll up your sleeves" and drive a wide-ranging set of projects, processes, and deliverables
- Meticulous attention to detail – ability to review contracts for discrepancies
- An independent worker who can run down problems with relatively little direction, knows when and how to escalate effectively
- Prior experience building from the ground up or scaling a provider network or contract management function at a high-growth healthcare organization preferred
- Expert proficiency in both MS Excel and PowerPoint
- Ability and willingness to travel 50% of the time or business need dictates
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