Network and Vendor Operations Manager (Health Plan)
July 31
🔄 Hybrid – Los Angeles
Description
• Manage and provide third party oversight including attestation tracking, vendor governance, auditing oversight, risk management, credentialing and ensuring necessary vendor trainings are up to date • Identify opportunities to build positive business relationships with potential providers by connecting within the community along with other myPlace leaders • Develops contractual relationships with service providers, drafts contract agreements, and maintains provider network listings • Partnership with Quality and Compliance team on the establishment of mock audits in preparation for future State and CMS audit readiness • Support provider network administration, including managing our catalog of contracts, properly loading all contracts into required systems/vendors, and delivering new vendor/provider onboarding • Support Operations, IT, Finance and other key departments with procurement, vendor management and tracking of various contract types • Co-lead regular reviews with the Quality & Compliance Director Improvement Manager/Compliance Officer to coordinate quality assessment of providers including onsite visits of providers • Ensures that applicable websites are monitored monthly and as needed for disciplinary summaries from the Board of Medical Examiners, as well as excluded providers from Medicare and Medicaid (OIG) • Collaborate with the central and local owners of the vendor relationship and support in ongoing monitoring of vendor performance as needed. • Implement a regular standing meeting with key contract owners at the time of renewal to evaluate performance and contract continuance. • Develop structure for contract repository system to manage that all executed agreements with quality controls in place to ensure all contracts are up to date and tracked. • Collaborate with Quality and Health Plan Compliance teams as needed for any related Fraud, Waste & Abuse (FWA) tracking of vendors/providers • Manage and provide oversight to selected other external vendors related to any of the functions listed above and more, ensuring quality and adherence to protocols • Develop policies and procedures that meet applicable PACE program requirements • Stay current on regulations and policies impacting the PACE program, health plan operations, and our compliance program and share that knowledge across the organization • Assist the company in ad hoc special projects, including collaborations with external partners, vendor contracting, and other operating model decisions • Continuously seek improvements to processes and systems across functions as the size and complexity of our business grows • Communicate confidently and persuasively to all audiences, including external stakeholders
Requirements
• Passion and mission orientation for serving high-risk seniors and frail older adults • Strong understanding of health plan, healthcare provider & vendor contracting and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization • Thrives in a relatively undefined, “zero to one” environment – unafraid to “roll up your sleeves” and drive a wide-ranging set of projects, processes, and deliverables • Preferred 5+ years of related experience in a similar role and education concentration (e.g., certification, Bachelor’s, or Master’s) in a related field (e.g., business, legal, healthcare administration/MHA, etc.) • Experience in corporate health plan, venture-backed startups, private equity, investment banking, or other finance-focused roles in high-growth and entrepreneurial environments • Meticulous attention to detail – ability to review contracts for discrepancies • An independent worker who can run down problems with relatively little direction, knows when and how to escalate effectively • Prior experience building from the ground up or scaling a provider network or contract management function at a high-growth healthcare organization preferred • Expert proficiency in both MS Excel and PowerPoint required
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