Description
Position Purpose: Manage all aspects of vendor activity for Utilization Management staff vendors.
Key Details: The Manager, Vendor Management position is primarily remote. Candidates will be considered nationwide.
Responsibilities:
- Manage vendor utilization including workflows for coordinating services
- 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 to coordinate with high-priority providers and vendors
- Coordinate with cross functional teams regarding vendor expectations, performance, and procedures
- Coordinate with Medical Management, Member Services and Provider Services 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
- Receive and respond to provider related database information requests and concerns
- Ensure operation integrity, including compliance with all policies and procedures including adherence to state and federal contracts and guidelines
- Request and/or assist in the development of correction action plans for standards that are not met by the vendor
Highly Preferred Skills:
- Clinical vendor management experience
- Leadership background
- Managed care experience (Medicare/Medicaid/Commercial)
Education/Experience: Bachelors’ degree in public health, business 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.Pay Range: $87,700.00 - $157,800.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
