Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Director, Vendor Performance Mgmt.

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Director and Equivalent
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210DJ Requisition #
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Summary:

  • Proactively drive Medical Management Special Populations vendor operations priorities and performance to achieve quality, efficiency, customer experience, strategic goals, and contractual targets.
  • Manage leadership and line management of vendors to continuously improve operational performance for claims, customer service, benefit set-up, enrollment and billing, provider set-up and medical and pharmacy core processes to achieve end-to-end results across the EmblemHealth and ConnectiCare value streams, processes and technologies.  Reassess process, policy, procedure, service level agreements, and reporting needs.  
  • Drive and promote improved organizational-wide business results, customer value, and experience through proactive cross-functional initiatives and tightly managing the interdependencies between people, process and supporting technology. 
  • Personally own the EmblemHealth (including CCI) brand and customer experience by directing day-to-day vendor operations and establishing seamless cadence with line management counterparts at each vendor.  
  • Direct and review all hiring and training events at each vendor site. Handle all customer and compliance/regulatory issues and coordinate actions across the different sites under business-as-usual and system transition and member migration scenarios.
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Responsibilities:

  • Drive operational performance of vendors for each core process to meet contractual requirements and align with EmblemHealth strategic objectives. 
  • Direct day-to-day vendor operations via daily staff meetings (including team leads), capability analyses, on-site and transactional audits, quality program verifications, compliance reviews, customer experience surveys, knowledge management and policy & procedure reviews, daily or weekly huddles with line management counterparts, operational and compliance corrective action drilldowns and formal Tollgate reviews. 
  • Re-evaluate appropriateness of service levels and initiate change requests when needed.
  • For day-to-day vendor line management: hold daily and weekly huddles (including team leads); assess risk, opportunities, and challenges, drive priorities and formulate tactics and strategies to mitigate and avert risk; drive transactional issues to resolution; handle customer service inquiries to ensure complete, accurate and timely responses; provide retained  staff as human capital to problem solve and address root causes as well as conduct UAT; review hiring, training and work force management plans as needed and measure effectiveness of implementation; and measure effectiveness of current line management staff to lobby for their removal from the EH account as needed.  Ensure vendor performance management procedures align with quality standards.  
  • Initiate and drive organizational-wide cross-functional reviews that focus on and promote end-to-end process reviews, establishment of workflows, accountability, and gap closure on an as needed basis.  Lead cross-functional performance improvement initiatives focused on quality, efficiency and customer experience and aligned with strategic objectives such as Medicare STARS. Establish KPIs and metrics for all initiatives to objectively baseline and target performance objectives. Report-out results to sponsors of projects and initiatives  
  • Communicate and collaborate with internal stakeholders (including but not limited to Marketing and Communications, Product Management, Network and Medical Management, Enterprise Pharmacy Solutions and Quality Management) as needed to share data/trends, promote change, achieve optimal performance, and support overall EmblemHealth strategic and tactical objectives. Be proactive and clear (use Executive Briefing Tool). 
  • Support Vendor Management and Procurement during request-for-proposal, vendor assessment and selection and vendor onboarding events. During these events, establish standardized objectives, requirements and KPIs/metrics, evaluate potential vendor capabilities and prioritize selection of vendors based on on-site assessments of operational capability/feasibility to meet performance objectives.
  • Foster a collaborative environment and continuously coach and mentor direct reports and vendor staff to achieve higher levels of Vendor Operations Management competencies. Identify and address gaps for developing competencies.  Continually assess activities and processes to ensure efficiency, effectiveness, and added value.  
     

Qualifications:

  • Master’s degree desirable: BS or BA required
  • 10+ years of relevant experience in Operations Management and Improvement, Change Management, Pharmacy Benefit Management and Customer Experience required
  • Experience with outsourced processes and vendor management and/or Lean Six Sigma certification a plus 
  • Achieve Vendor Management certification or equivalent certification within 1 year of assuming this role 
  • Strategic and tactical perspective on how to significantly improve operational performance required
  • Ability to manage vendor line management and their respective staffs on a day-to-day basis required
  • Working knowledge of FACETS, EAM, SalesForce CRM Service Cloud required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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