Description
Position Purpose: This position is responsible for the strategic development of contractual relationships with the plan's major vendors currently providing dental, vision, pharmacy and transportation services. This position manages all aspects of oversight for the operational, contractual, financial, network adequacy, utilization and quality management aspects of these relationships to assure compliance with all contractual and regulatory requirements and to meet the goals of the plan. In total this position will manage all aspects of these vendor relationships that currently exceed $1.2 billion in annual costs. This position is part of the plan's Senior Management team.
- Responsible for the development of strategic contractual and business relationships with all vendors to assure that optimum quality, service and cost outcomes are achieved in alignment with the plan's goals and objectives. Responsible for identifying opportunities to expand vendor relationship opportunities.
- Responsible for monitoring the operational aspects of the vendor relationship through spearheading the design, and execution of audits and evaluations of financial and operational performance that will confirm that contract terms, standards and expectations are met, which includes Internal operations (Claims, Appeals & Grievances, and Membership).
- Ensures that vendors adhere to all applicable legal, regulatory and accreditation mandates. Manages the relationship governance process to ensure compliant operations and monitors fulfillment of contract obligations. Responsible for service level management and reporting; publishes and manages performance and/or KPI monitoring.
- Responsible for clear, consistent and pertinent communications with vendors relative to all oversight activities and coordination of communications with internal PLA staff as necessary.
- Assumes other duties as assigned.
- Performs other duties as assigned.
- Complies with all policies and standards.
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
