Manager Risk Adjustment Vendor Management (Finance)

Job Description:

Summary:

This position is responsible for supervising the activities of the assigned vendor management staff in accordance with the organization's project management methodology. This position develops, prioritizes, and submits project plans, budgets and methodologies across a range of key projects. Defines project resources, performance reviews and post implementation evaluations. The incumbent takes ownership of the successful implementation of a set of projects that collectively can comprise a program. Leads, directs, evaluates, and develops a team of project managers and project coordinators to ensure that projects are completed on-time, within budget and according to project specifications. Identifies and resolves operational problems and minimizes delays; evaluates and authorizes changes that significantly impact the scope, budget, or timeline of a project. This position is accountable for the performance of vendors within Risk Adjustment. Leads in the identification and selection of vendors by directing the RFP process, partners with Finance on the financial details of the contract, and partners with Legal to ensure the corporation is protected by the contract. Additionally, this position ensures all vended processes and interfaces are compliant with our security requirements. The incumbent works with cross-functional teams to lead the development; negotiation, execution, and governance of vendor arrangements to ensure realization of the expected value from the relationship. Executes risk adjustment vendor contracts and contract renewal negotiations. The incumbent in this position owns the on-going relationship and governance with the vendor(s) to ensure vendor performance meets contractual and customer expectations. Responsible for taking all necessary steps with procurement, accounts payable and security to ensure payment to the vendor.

Essential Responsibilities/Accountabilities:

• Plans, and coordinates matrixed team(s) activities to manage and implement interrelated projects from contract/proposal initiation through the final operational stage.
• Plans, schedules, monitors and reports on activities related to the project. Leads the business team(s) in determining customer requirements and translating requirements into operational plans.
• Determines, monitors and reviews all project economics to include project costs, operational budgets, staffing requirements, project resources and project risk.
• Works with various groups across the organization to define the scope of a particular special project and how that contributes to larger strategic goals and initiatives of a department and/or the corporation.
• Formulates contingency plans to address schedule revisions, resource adjustments, fund allocations and work requirements.
• Controls project requirements, scope and change management issues.
• Selects and applies appropriate tools to accurately estimate and plan the work of teams or project groups within agreed policies. Produces work plans according to required standards. Works with colleagues to produce/recommend/develop short term and long-term plans.
• Monitors and reports on the progress of the resolution of high impact problems according to established standards. Handles those exceptions that have been referred from below relating to target outcomes, schedules, working methods, resources, staff matter, or technical difficulties. Escalates decisions clearly outside scope upward, including proposed solutions whenever appropriate.
• Meets with management, sponsors, and business teams to review project scope/progress and resolve project issues.
• Establishes appropriate metrics for measuring key project criteria.
• Maintains knowledge on emerging vendors and risk adjustment approaches.
• Coaches and counsels' direct reports and members of cross-functional teams to accomplish projects, meet established schedules, or resolve technical/operational issues.
• Monitors and evaluates quality of performance and product from all work within scope of responsibility.
• Fosters an environment of continuous improvement. Constantly exploring ways to increase efficiency and productivity, reduce waste and reduce costs.
• Matrix manages cross-functional teams: Actuarial, Compliance, Legal, Contracting Center of Excellence, internal IT, external vendor partners, contractors, third-party consultants, etc., in delivering outcomes.
• Maintains knowledge of vendor applications, organizational policies, and organizational management structures and uses this knowledge to advise on and justify their current use.
• Leads strategic risk adjustment vendor outsourcing arrangements, and develops all communications related for the potential sourcing arrangement.
• Leads RFP vendor identification, evaluation, negotiation, selection, contracting and on-going management of vendor initiatives.
• Acts as the liaison between internal teams to support the implementation of contracts and vendor relationships from all workflows.
• Ensures that all contracts are signed by appropriate company officers, in full compliance with delegated authorization limits.
• Serves as a liaison between external vendors and internal staff to facilitate the evaluation, pricing and introduction of new products/services, problem resolution and program development.
• Ensures final contract documents are consistent with agreements reached at negotiations and implemented for operational governance.
• Coordinates and amends changes into contracts when determined by regulation (i.e. Health Care Reform, recent legislation from NYS DOH, etc.).
• Develop and maintain vendor renewal schedule to ensure timely contract renewal execution.
• Initiate, execute vendor contract renewal; lead re-negotiation discussion with vendor.
• Resolves contractual and pricing issues with vendor leadership. Monitors vendor performance against Service Level Agreements (SLAs) to ensure internal and external customer quality expectations and production turnaround timeliness metrics are met.
• Develops vendor performance metrics to monitor and evaluate performance as well as making recommendations for additions or deletions of vendors as appropriate. Completes the functions necessary to assure timely payment of vendors, including sole source justifications, purchase orders, security assessments and invoice approvals.
• Acts as the liaison between the Health Plan and vendor for all IT related inquires, such as internal audits, file requests, security assessments and security exception requests.
• Ensures each vendor is being managed using standard governance processes including but not limited to quarterly business reviews, vendor scorecards and escalation process.
• Provides justification of strategic plans and tactical plans affecting service delivery.
• Represents managers and directors of supported areas in all meetings pertaining to related projects, including decision-making responsibilities, attendance at Corporate and regional committees, meetings and workgroups.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.
• Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
• Performs other duties and functions as assigned by management.

Minimum Qualifications:

• Bachelor's degree in Business, Finance, Information Technology or relevant field. In lieu of a degree, a minimum of 6 years of related business experience is required.
• 3 years project management experience.
• PMI/PMP certification preferred.
• Lean Six Sigma Black Belt preferred.
• Demonstrated skills in executing vendor contracts and vendor oversight.
• Demonstrated experience managing teams executing under multi-phased and multi-deployment project schedules.
• Demonstrated experience communicating with users/customers, colleagues and senior management in various formats, informal discussions, written reports, scheduled meetings and executive level presentations.
• Knowledge and experience working in the healthcare, health insurance or similar industry.
• Demonstrated leadership skills.
• Demonstrated skills in developing and achieving project scope, costs and planning.
• Demonstrated skills in forming and fostering high performance, cross-functional teams.
• Demonstrated skills in quality principles including but not limited to root cause analysis and problem solving.
• Demonstrated experience with Quality principles and tools. Demonstrated business and technical problem-solving skills.
• Very strong analytical and business process development skills.
• Demonstrated competence in staff leadership and project leadership tasks.
• In-depth knowledge of application delivery, management structures and reporting procedures.

Physical Requirements:

• Ability to work prolonged periods sitting at a workstation and working on a computer.
• Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Typical office environment including fluorescent lighting.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural, and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and

benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Grade E7: Minimum $87,766 - Maximum $157,978

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.