Job Summary

This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, stakeholders, functional counterparts, and Core Operations leadership and exhibiting a strong understanding of operations, stakeholder needs and satisfaction, financial budgets, and current and future program initiatives. Ability to drive operational excellence and process-oriented efficiencies is essential as well as the ability to critically think to resolve business issues in a cost-effective and out-of-the-box manner. This position oversees vendor performance involving onshore and offshore resources, monitors regulatory compliance adherence (in conjunction with functional counterparts) and quality metrics.  Accountable for offering innovative guidance and solutions to address emerging business concerns and respond to growth initiatives in order to appropriately scale vendor relationships to meet business demands. Responsibilities include oversight of the onboarding of vendor resources, managing performance, monitoring, and mitigating risks to ensure service delivery by vendors is in accordance with the Service Level Agreements between the parties.

 

 

Job Duties

Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, including contract negotiation and SLA oversight Accountable for over-arching key vendor relationships and serves as liaison between stakeholders, functional counterparts, vendors, and Core Operations leadership Leads end-to-end vendor operations, ensuring alignment with the impacted stakeholders and business goals Partners with Finance to manage vendor budgets, forecast funding needs, and evaluate ROI on the covered benefits and its management Oversees vendor performance, compliance, and satisfaction, with a focus on minimizing gaps in member, vendor and stakeholder experience Aligns to Core Operations’ strategic direction and priorities toward a common vision; clarifies roles and responsibilities for staff; promotes empowerment Staffs, organizes, monitors and maintains an effective, consistent Vendor Management function Supervise Molina Healthcare vendor management staff Ensures departmental and individual performance goals are met Oversees multiple initiatives of varying size (scale), complexity, and duration involving staff and matrixed resources Translates strategy into tactical business activities, acting as a change agent Serves as focal point of escalation for vendor issues and disputes, and drives issues to resolution Makes needed decisions to ensure the successful resolution of all issues, problems and changes within the program so as not to alter or defer significantly from the agreed upon performance targets, milestones and major deliverables Leads communication with authority with individuals and groups in a manner that engages and helps them understand and retain information, drive decision making, achieve consensus and define/reinforce expectations Facilitates program scoping discussions, definition of program success measures, and setting of expectations for cross-functional program teams with a focus on business outcomes and benefit realization Demonstrates deep understanding of Core Operations, Claims and Enrollment processes, deliverables, vendor partners and technology platforms Monitors performance metrics and goals for assigned programs, including process measures, outcomes measures, financial measures and methodologies for implementing programs Oversees direct reports’ interactions with functional counterparts and vendors in tracking inventory levels, Turn Around Times (TATs), and other key performance metrics in a timely and appropriately documented manner Regularly assesses areas of responsibility for improvement opportunities, applies Business Analysis Best Practices, and establishes goals/performance targets to demonstrate measurements of success Identifies and assesses risk and facilitates the creation of mitigation/contingencies strategies with relevant parties to address the exposure Manages vendor funding requirements, forecast allocations and invoice reconciliation activities.  Initiates requests for additional vendor funding as required. Oversee the review, reconciliation, and approval of invoices for payment of services rendered by vendors and understand vendor billing process  Adheres to and consistently applies organizational and departmental policies, procedures, and protocols Meets regularly with vendors, primarily via videoconferences, occasional site visits to assess productivity, quality, compliance Articulates the goals and objectives of Molina Healthcare business units to vendors supporting operations of those units Assists in establishing standards to assess the performance of vendors Oversee evaluation of vendor performance and compliance, including providing reporting and analytical data to Molina Healthcare leadership and key stakeholders. Responsible for maintaining, enhancing relationship between Molina Healthcare and vendors; as needed implement corrective action plans to address non-performance

 

Job Qualifications

 

REQUIRED EDUCATION:

Bachelor’s degree in Business or a Related Field of Study.  Years of experience in lieu of education is acceptable.

REQUIRED EXPERIENCE:

7+ years of experience in Healthcare (payer experience), Vendor Management, Data Analytics, Contract Terms and Conditions, Procurement, Project Management, or Account Management Proficient with Microsoft Office Suite, databases, advanced spreadsheets, pivot tables, v-lookup and corporate email and collaboration solutions Demonstrate strong written and verbal communication skills, presentations skills and ability to successfully interact with all levels of management Exhibit excellent customer service skills and attention to detail. Ability to problem solve and critically think to resolve business issues Proficient in time management, organizational skills and managing multiple priorities

Operates independently in a matrixed organization and escalates issues and concerns as appropriate

PREFERRED EDUCATION:

Graduate degree

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.