Position Purpose: Manage all aspects of vendor activity, including but not limited to dental, ancillary, behavioral health, pharmacy and vision vendors for the Health Plan
Manage vendor utilization including work flows for coordinating services with the Health Plan
Analyze vendor data and complete required reports for the health plan, Corporate and state
Create and manage vendor scorecard and associated ratings/correction plans
Perform as a key account manager for the Health Plan to coordinate with high priority providers and vendors
Coordinate with Corporate Vendor Management team regarding vendor expectations, performance and procedures
Coordinate with various cross-functional departments to educate and communicate expectations, performance and procedures to vendors
Conduct monthly meetings and document discussions, issues, attendees, action items
Research and resolve claim disputes with vendor, member or provider issues and route to appropriate person(s) for resolution
Ensure operation integrity, including compliance with all policies and procedures for the Health Plan including adherence to state contract and guidelines
Request and/or assist in the development of correction action plans for standards that are not met by the vendor
Education/Experience: Bachelor's degree in Business Administration, Public Administration or related field or equivalent experience. 4 years of healthcare management experience, preferably in vendor managed care or the health insurance field. Experience with reporting and analyzing data preferred. Strong Excel skills and working with a variety of software data programs preferred. Project management experience a plus.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.