Government Programs Vendor Operations Manager. Job in Seattle WestCoast-Jobs

  • Job Reference: 462942623-2
  • Date Posted: 2 January 2022
  • Recruiter: Cambia Health Solutions, Inc
  • Location: Seattle, Washington
  • Salary: On Application
  • Sector: Government & Defence
  • Job Type: Permanent

Job Description

The position can be remote in the four Cambia states - OR, WA, ID or UT
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.
The Government Programs Vendor Operations Manager provides support related to management of vendors for program evaluation, development, ensure regulatory compliance, implementation, and management. Build and own relationships with internal vendor business owners in Medicare Operations. Facilitate and support the implementation of new programs and the enhancement of existing programs delivered through a vendor relationship, or in a hybrid model.

Minimum Requirements:
  • Familiarity with CMS guidelines and audits; including compliance of Medicare and Medadvantage products.
  • 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 partners.
  • Ability to supervise 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 Operations.
  • Extensive knowledge of CMS and state regulatory requirements and demonstrated ability to lead 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 sophisticated 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 improvement solutions.
  • Solid understanding of data abstraction and quantitative, qualitative, and analytical skills.
Normally to be proficient in the competencies listed above:

Government Programs Vendor Operations Manager would have a bachelor's degree in Business Administration, or certificate in project management, or 5 years' experience with an area of focus (vendor management/project 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. Previous vendor management experience.

This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit .

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.

Job Requirements:
Responsibilities:
  • The Government Programs Vendor Operations Manager will be able to effectively collaborate with internal program leaders, vendors and/or a combination of internal and external resources to resolve implementation, compliance, and program design challenges.
  • Manage moderate to sophisticated vendor relationships ensuring the steadfast pursuit of desired outcomes, cost savings and favorable terms. Understand vendor contracts and service level agreements.
  • Educate and train 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. Collaborating with internal & external business partners on the collection, analysis, and maintenance of relevant data.
  • Provides leadership and operational oversight of vendors. Leads vendor relationships in collaboration with Sourcing. Organizes and updates the Government Programs library of contracted vendors.
  • Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards. Develop monitoring and control procedures to support the Risk Adjustment activities. When applicable, lead quarterly auditing in support of CMS Audits.
  • Drives continuous improvement in all aspects of the vendor oversight process, including the evaluation of operational program outcomes.