Manager, Dental Vendor Performance

• 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
• Resolving all issues related to ancillary delegated relationships
• Serve as Liaison between vendors and cross-functional internal departments and teams to ensure timely and quality deliverables from vendors and internal departments such as Network, Claims, IT/IS, Medical Management, Credentialing and other areas as needed
• Acts as a liaison between other departments and delegates related to CMS/NYSDOH audits, member complaints, etc. Collaborates with other departments within Healthfirst to improve all aspects of a delegated functions including member satisfaction
• Responsible for contract negotiations and renewals
• Track and trend Performance Guarantee and key performance indicator related to contractual penalties or incentives
• Provide Director with performance data on vendors based on contractual requirements and Service Level Standards on a monthly/quarterly basis
• Maintain effective working relationships with delegated vendors and internal business stakeholders to ensure performance metrics are met, identify opportunities for improvement, mitigate risk and eliminate barriers to correct Corrective Action Plans (CAPs)
• Participate in Vendor Oversight Committee, Joint Operating Committees and other ad hoc meetings/activities as directed
• Analyze, track and follow-up on the timely resolution of errors and issues that are a result of vendor processes
• and as necessary escalate unresolved inquiries/complaints to Manager
• Maintain and update an Issue Tracking Log for delegated vendors
• Perform review of SDOH, CMS and other internal/external audit templates to validate data
• Serve as a project coordinator to lead projects/vendor configurations as assigned, develop project plans, support workgroup and monitor vendor and internal deliverables
• Assist and lead implementation strategies to improve delegated vendor engagement strategies for HEDIS and STARS Quality Initiatives
• Participate in Request for Proposal (RFP) process from initiation, contracting and onboarding for potential new delegates
• Analyze, update, and modify procedures and processes to continually improve operations
• Monitor and report instances of vendor Corrective Action Plans (CAPs) implement CAPs as necessary
• Perform IT User acceptance testing (UAT) assessments related to enrollment files, claims reporting, encounter data files, accumulator files and as needed reviews for IT changes which impact the delegate
• Monitor electronic feeds and User acceptance testing (UAT) to ensure receipt/transmit data files to delegates
• Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows

• Bachelor's degree from an accredited institution or equivalent work experience
• Delegated vendor management oversight work experience
• Experience communicating and influencing impact and progress to senior leadership
• Domestic and international travel may be required

• Expertise in healthcare operations
• Management experience in an operational department within the healthcare industry
• Experience developing strategy and processes for a department or function

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions