Clinical Delegation Vendor Relations Manager - UM RN role

Overview

About us:

Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief summary of purpose: 

The clinical delegation vendor relations manager is responsible for handling multiple delegated UM healthcare vendor relationships as the main point of contact, managing the day-to-day operational work, delegation oversight, associated projects and instituting and monitoring operational metrics. This position will collaborate with various internal departments and program/product stakeholders at all levels to support the governance of the vendor contract relationships. This will include but not be limited to evaluating and prioritizing multiple requests put forth by internal departments/stakeholders, cadence of joint operating meetings, potential change in scope of vendor contracts and problem resolution and corrective action plans. Key interface between Fallon Health Regulatory Compliance and healthcare vendor and to ensure healthcare vendor is in compliance with federal and state requirements.

Responsibilities

Primary Job Responsibilities: 

Performance Management:

• Develop and institutionalize operational metrics
• Research, collection, tracking and reporting of vendor metrics
• Develop and maintain vendor scorecard to be reviewed with vendor and internal departments and stakeholders
• Conduct vendor delegation audits and meetings to review vendor performance linked to regulatory compliance and contractual obligation

Main point of contact for vendor and internal departments:

• Track escalated issues and reporting of root cause analysis
• Troubleshoot all vendor problems and present to management as required
• Identify and implement continuous enhancements and efficiencies associated with vendor management
• Perform regulatory compliance and performance of Fallon’s vendors
• Maintain vendor information and share with internal team related to contract obligations and day-to-day updates

Other duties: may also be assigned if needed

Qualifications

Bachelor’s degree or equivalent work experience required.  Master’s degree in Business Administration, Healthcare Administration, or Public Health preferred but not required.  Project Management experience valuable but not required.

License/Certification: 

RN Clinical licensure required

Experience: 

Minimum of three years’ experience in managed healthcare environment(s) or equivalent experience with related work in provider/healthcare vendor contracting, provider/healthcare vendor relations, utilization and care management, delegation oversight healthcare finance, provider reporting/profiling, and/or project management. Analytical, organizational, strategic and creative thinking skills are required.  Excellent verbal, written and computer skills (Microsoft Word, Excel, Power Point) are essential to this position. 

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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