Aug 22, 2019
WellCare Health Plans Manages third party program relationships with high volume ancillary vendor partners for performance management standards, financial responsibility and proactively implements appropriate business solutions as required. Acts as the critical link between our vendor partners and their account management for delivery of vendor services. As the company's operations representative, this position manages the facilitation from initial launch of services through day to day interactions. Has complete ownership of vendor monitoring, reporting and improving vendor performance. REPORTS TO: VP, BUSINESS PERFORMANCE DEPARTMENT: PHS-ADMINISTRATION POSITION LOCATION: Raleigh , NC Essential Functions: Interfaces with WellCare associates and vendors to identify strategies to meet state and federal contractual requirements Independently manages project plans through execution Chairs monthly cross functional JOC meetings with vendors, markets and internal parties to review vendor performance and vendor projects with follow up on action times and report on status Monitors vendor against SLAs, assigns financial penalties as appropriate and works with vendor to resolve Business owner and main point of contact for assigned vendors Identifies and executes on process improvement projects to improve efficiency and vendor management Monitors and manages vendor delegation and, in some cases, places vendors on corrective action plans (CAPs) and works with vendor to ensure they meet complete requirements of CAP by targeted date Acts as single point of contact and escalation for vendors and coordinates issue resolution with manager and senior management if needed Escalates urgent or critical vendor performance issues to manager for further evaluation and provides a remediation plan Acts as main point of contact for escalation issues for vendors and coordinates issue resolution with applicable internal representatives Reviews monthly CAP models to ensure vendors are being paid for correct membership and rate Works with vendors and internal departments to develop and complete vendor implementations for new vendors, LOBs, markets, etc. Provides monthly and quarterly summaries to management on scorecard performance Meets or exceeds company objectives for vendor performance Provides prompt and proper resolution to internal business owners' requests at all times Verifies and implements business requirements for various vendor programs to meet contractual requirements, RFPs and other business needs Performs other duties as assigned Candidate Education: Bachelor's Degree in a related field is Required or equivalent work experience 2 additional years of vendor management or oversight preferably with healthcare vendors Candidate Experience: 4 years of experience in Handling service issues for members and providers is Required 4 years of experience in vendor management or oversight preferably with healthcare vendors is Required Demonstrated aptitude and experience for managing processes across functional teams is Required Solid understanding of manage care, vendor provider agreements and the delegation process is Required Medicare/Medicaid health plan experience Candidate Skills: IAbility to effectively present information and respond to questions from peers and management Demonstrated written communication skills Demonstrated interpersonal/verbal communication skills Demonstrated analytical skills Ability to drive multiple projects Ability to influence internal and external constituents Demonstrated negotiation skills Ability to represent the company with external constituents Ability to work in a fast paced environment with changing priorities Ability to work independently Ability to communicate and make recommendations to upper management Solid understanding of manage care, vendor provider agreements and the delegation process Ability to handle responsibilities that are complex with results that may have long-range implications Ability to remain calm under pressure Technical Skills: Microsoft Excel is Required Microsoft PowerPoint is Required Microsoft Word is Required About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Professional Diversity Network Raleigh, NC, USA Full-Time