Office Locations and Remote only within ID, OR, UT, WA
At Cambia, our members need us more than ever, and to continue serving them, we need to be vaccinated. Following federal mandate, all Cambia Health Solutions employees, including 100% remote workers, need to be fully vaccinated for COVID-19 by 1/1/22.
Healthcare Services Vendor Manager I provides support related to program evaluation, development, ensure regulatory compliance, implementation and management. Supports the implementation of new programs and the enhancement of existing programs delivered internally, through a vendor relationship, or in a hybrid model. Build and own relationships with internal customers in Healthcare Services management, vendors, vendor management and numerous departments within the company to achieve successful implementation of new or enhancement of existing programs
Effectively collaborates with internal program leaders, vendors and/or a combination of internal and external resources to resolve implementation, compliance, and program design challenges.
In conjunction with internal operational leaders and/or vendor management, develops monitoring and control procedures.
Manage moderate to complex vendor relationships ensuring the relentless pursuit of desired clinical outcomes, cost savings and favorable terms.
Educates and trains the leadership, staff, and business associates regarding new program elements and implementation.
Maintains a system for ongoing data/statistical reporting and program assessment. Responsible for the development and maintenance of vendor program documents, reports, etc.
Collaborates with internal & external business partners on the collection, analysis, and maintenance of relevant data.
Provides leadership and operational oversight of vendors. Manages vendor relationships in collaboration with vendor management. Leads the daily interface with vendor partners.
Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
Utilizes Cambia processes and knowledge to ensure compliance with program design, contractual requirements, accreditation standards and accepted standards of care.
Drives continuous improvement in all aspects of the vendor oversight process, including the evaluation of clinical and non-clinical program outcomes.
Ability to evaluate program effectiveness, identify issues and opportunities, and work to continuously improve programs offered. Ability to analyze financial measures associated with process improvement activities.
Strong communication and facilitation skills, including the ability to resolve issues with diplomacy and persuasiveness, and build consensus among groups of diverse stakeholders.
Ability to track and analyze performance data and translate data into insights for decision making.
Knowledge of health insurance industry trends and technology.
Experience in areas of Healthcare Services practices.
Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to manage compliant operations. NCQA and/or HEDIS accreditation experience preferred.
Ability to coordinate cross-functionally to drive solutions and resolve issues in a timely and effective manner.
Demonstrated experience in complex program oversight.
Familiarity with contract language and understands and can identify contractual risk, with an ability to mitigate risk.
Demonstrated experience in designing and implementing process and technology improvement solutions.
Strong knowledge of data abstraction and quantitative, qualitative and analytical skills.
Normally to be proficient in the competencies listed above
Healthcare Services Vendor Manager I would have a/an Bachelor's Degree in Nursing, Health Care Administration, or related field, 5 years' experience with an area of focus (e.g. care management or utilization management) in healthcare insurance operations and/or managing leading complete projects/programs and working with third party service providers or equivalent combination of education and experience. Masters preferred. Previous leadership experience preferred.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.