Manager, Vendor Oversight and Analytics #20-1987

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

Lansing, MI

Advantasure

<strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong> https://advantasure.com/

keywords: summary,leadership,support,project management,performance,compliance,analysis,education,experience,certification,management,quality assurance

Full-Time

Competitive Compensation and Benefits Package

Overview: This position assists Leadership in the planning, development, and implementation of programs to monitor the performance of vendor-supported products, programs, and services related to the company's Medicare programs as well as support operational processes as per CMS requirements.<br /><br /> <div><strong>THIS POSITION CAN BE LOCATED REMOTELY ACROSS THE U.S.</strong></div>
Responsibilities: <ul> <li>Supervises, sets performance goals/objectives, monitors performance, evaluates, and mentors operational and analytical staff to support vendor supported processes</li> <li>Lead team of analysts to support multiple CMS, internal and corporate audits including yearly data validation audit and internal MAR audit</li> <li>Develop, implement, and maintain processes to pharmacy operational and clinical reporting</li> <li>Manage reporting and analytical work for multiple stakeholders including finance and actuary teams</li> <li>Lead developmental tasks to improve the vendor oversight processes</li> <li>Serves as a key subject matter expert for all CMS and client reporting requirements</li> <li>Manages all aspects of contracting with internal and external vendors and support leadership with contracting language</li> <li>Lead bi-weekly vendor oversight leadership meetings and support leadership to make key decisions about vendor oversight and performance</li> <li>Lead a team of analysts to develop and track performance guarantee metrics to monitor the vendor performance</li> <li>Lead initiatives to support various operations and clinical initiatives</li> <li>Coordinate with compliance and program oversight teams related to CMS guidance</li> <li>Assists leadership with the creation of dashboards and other related reports to support key decision making</li> <li>SME for system requirements or enhancements to support vendor applications and act as an IT liaison to implement business readiness activities</li> <li>Lead a team to gather evidence of annual FRD attestation documentation and CMS readiness checklist</li> <li>Coordinate with project management office to write business cases and get the approvals</li> <li>Responsible for balancing workload to optimize the effectiveness of the department.</li> </ul>
Requirements: <p><strong>EDUCATION:</strong></p> <p>Bachelor's degree in business or related field. MBA degree is preferred.. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification in business analysis or progress toward certification is highly preferred and encouraged.</p> <p><strong>EXPERIENCE:</strong></p> <p>Seven years experience of progressive responsibility in a Medicare health plan or pharmacy environment. Five years of supervisory or lead experience In a health plan vendor oversight role</p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Proficient in data analytics platform for supporting pharmacy reporting needs</li> <li>&nbsp;</li> <li>Thorough knowledge of Medicare medical and pharmacy products including both HMO and PPO benefit plans</li> <li>Understanding of CMS guidance and interpreting the rules to build internal processes</li> <li>Demonstrated ability in Business analysis to provide appropriate solutions based on CMS guidance</li> <li>Demonstrated ability to successfully manage internal and external stakeholder relationships</li> <li>Decision making, organizational, and problem-solving skills.</li> <li>Excellent analytical skills.</li> <li>Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management.</li> <li>Ability to work with and empower others on a collaborative basis to ensure success of unit team.</li> <li>Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions and employing active listening techniques.</li> <li>Ability to effectively identify gaps in business process and develop solutions to remediate the compliance risks</li> <li>Ability to establish workflows, manages multiple projects, and meets necessary deadlines.</li> </ul> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.</p>