Clinical Vendor Program Manager III

Medica•Minnetonka, MN

12h•Hybrid

About The Position

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for. We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued. The Program Manager role is responsible for oversight, operational execution, and continuous improvement of Care Management vendors that support high quality, member-centered care. This role works cross-functionally by coordinating closely with both external vendor partners and internal operational, clinical, and technical teams to ensure compliance with contractual obligations, regulatory requirements, and organizational standards. The Program Manager serves as the primary liaison between the organization and the vendor driving performance, quality, and program success to meet and support Medica’s mission, vision and desired outcomes. Performs other duties as assigned.

Requirements

Bachelor's degree or equivalent experience in a related field
5+ years of work experience beyond degree

Nice To Haves

Experience in NCQA, specifically PHM standards preferred
Proficiency with Microsoft Office applications, including Word, Excel, Outlook, and OneNote, as well as the ability to learn and utilize additional software tools
Demonstrates sound judgement in navigating vendor communications, ensuring appropriate transparency while protecting organizational interests
Uses critical thinking and clinical context when identifying issues within workflows, documentation, or member care processes
Strong ability to manage multiple vendors in parallel while adhering to operational priorities
Excellent written and verbal communication skills, with the ability to interact professionally across all levels of the organization
Experience setting expectations and providing direction to support team performance, accountability, and operational excellence

Responsibilities

Oversee day-to-day operational performance of care management workflows and serve as the primary point of contact for the vendor
Facilitate structured, recurring vendor meetings to review performance, address issues, and align on priorities
Monitor vendor performance against contractual obligations, KPIs, and service-level agreements (SLAs)
Ensure program adherence to regulatory requirements and lead readiness and response efforts for audits and reviews
Maintain program outcome data and conduct regular analysis of performance and member engagement metrics to identify trends and opportunities for improvement
Manage cross-functional relationships including but not limited to: Analytics, Product Leaders, IT, Sourcing and Finance
Conduct quarterly and annual vendor performance reviews, identifying strengths, gaps, and needed corrective actions
Partner with business analyst and analytics teams to optimize care management dashboard and reporting tools
Review and reconcile all program invoices, ensuring accuracy and adherence to spend
Communicate ongoing vendor performance results, risk assessments, and mitigation strategies to stakeholders to support informed decisionâmaking and program oversight
Facilitate complex conversations with vendors to achieve Medica's desired outcomes