Vendor Management Lead

Humana

20h • Remote

About The Position

Become a part of our caring community and help us put health first The Vendor Management Lead oversees vendor management operations from a market perspective, ensuring alignment with Humana’s clinical and operational standards. This role directs a team of RN professionals, fosters effective vendor and provider relationships, and drives resolution of clinical and operational issues to support quality care and compliance. The Vendor Management Lead (RN) is responsible for overseeing the vendor management functions from a market perspective, ensuring alignment between Humana’s business and clinical operations, vendor partners, and providers. This role provides strategic direction, leadership, and support to a team of Senior Vendor Management Professionals (RN), facilitating effective issue resolution, gap identification, and process optimization to advance quality care and operational excellence. This leader will build positive strategic partnerships with Contracting to align on Institutional Special Needs Plan providers and have oversight of SNF provider network and optimization from the clinical perspective. This role will also work with Provider Engagement to monitor outcomes for Value Based and Delegated Services Providers.

Requirements

• Active and unrestricted Compact license (RN) license required
• Prior experience in a healthcare or insurance setting
• 5 + years of Utilization Management experience
• 3 + years of vendor management and/or process or project management experience
• Demonstrated ability to define and track KPIs and/or service level agreement metrics and other measurable success criteria
• Proven verbal and written communication skills with the ability to interact effectively across all organizational levels
• Ability to break down complex problems into actionable steps
• Demonstrated critical thinking and analytical problem-solving skills
• Exceptional relationship management skills
• Demonstrates accuracy and thoroughness, identifies process improvements
• Proficient in Microsoft Office applications including Word, Excel and PowerPoint
• Advanced facilitation skills with experience leading cross-functional discussions

Nice To Haves

• Master's Degree
• Knowledge of claims processes
• Knowledge of Stars and HEDIS
• Knowledge of clinical quality benchmarks and reporting requirements for value base providers
• Certification with Six Sigma and/or the Project Management Institute
• Knowledge of Medicare Advantage Grievance and Appeals experience

Responsibilities

• Provide strategic leadership and guidance to the Senior Vendor Management Professional (RN) team, ensuring effective execution of vendor management initiatives in accordance with Humana’s policies and regulatory requirements.
• Oversee and optimize vendor relationships, including performance monitoring, compliance management, and the resolution of complex operational and clinical issues.
• Facilitate collaboration between Humana, vendor partners, and providers, ensuring clear communication channels and the successful implementation of market-based strategies.
• Support the review of clinical authorizations and ensure consistency with established guidelines for various levels of care, leveraging clinical expertise and best practices.
• Identify systemic gaps and process improvement opportunities across vendor partnerships, developing and implementing action plans to close gaps and enhance service delivery.
• Analyze market trends, operational data, and vendor performance metrics to inform decision-making and drive continuous quality improvement.
• Ensure adherence to privacy, security, and enterprise information protection protocols, escalating issues as appropriate and maintaining compliance with internal procedures.
• Mentor and develop team members, fostering a culture of accountability, collaboration, and professional growth.
• Participate in strategic planning, vendor selection, and contract negotiations as needed, ensuring alignment with organizational objectives and clinical standards.
• Represent the vendor management function in cross-functional meetings, audits, and enterprise initiatives.

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level