Manager of Vendor Oversight

Overview

The Manager of Vendor Oversight: D-SNP supports sourcing, contract execution, and
performance management for vendor partners that directly support Partnership Advantage Dual
Eligible Special Needs Plan (D-SNP). This position is responsible for relationship management
with assigned vendors, as well as oversight of the contractual performance, maintenance of the
vendor to ensure performance and compliance, building governance structures (JOC/AOC),
implementing performance monitoring frameworks and ensuring all vendors meet regulatory and
operational requirements during D-SNP implementation and after go-live. This position will be
responsible for building relationships with business owners across the organization including:
Compliance, Operations, Network Contracting, IT, and Quality teams to ensure vendors are
integrated and compliant. They serve as the primary liaison between Compliance and external
partners to maintain audit readiness and operational excellence.

Responsibilities

• Vendor Management

• Leads the implementation and onboarding of key DSNP vendors.
• Works with internal business partners on the management of vendor Service Level
  Agreements (SLAs) and Key Performance Indicators (KPIs). This includes receiving
  vendor reports, arranging and attending Joint Operations Meetings (JOC), reviewing,
  and documenting vendor performance and working with Compliance to assess
  corrective action plans (CAPs) where applicable.
• Collaborates with internal and external business partners on the collection, analysis,
  and maintenance of relevant data.
• Supports the development of plans and operational solutions to address changes to
  vendor programs on an annual basis.
• Develops vendor readiness plans, timelines, and deliverables aligned with CMS
  application and Annual Enrollment Period (AEP) launch milestones.
• Partners with Legal and Compliance on contracting to ensure inclusion of compliance
  and performance provisions.
• Establishes governance cadence - weekly stand-ups, monthly performance
  meetings, and readiness checkpoints.
• Leads day-to-day relationship management of delegated DSNP vendors.
• Conducts regular vendor performance monthly reviews and quarterly business
  reviews (QBRs).
• Ensures vendors adhere to operational timelines, data quality standards, and reporting
  requirements.

• Compliance and Regulatory Management

• Supports Compliance and Regulatory teams to prepare for CMS and state readiness
  reviews, including submission of vendor documentation.
• Ensures that the D-SNP Program and related processes adhere to regulatory and
  contractual requirements, laws, accreditation standards, and regulations, including
  Medicare Advantage, Centers for Medicare and Medicaid (CMS), Department of
  Managed Health Care (DMHC), and the Affordable Care Act.
• Collaborates with Compliance, Quality, and Regulatory Affairs to ensure delegated
  oversight program meets CMS requirements.
• Reviews and validates vendor compliance attestations and documentation (policies,
  procedures, training, etc.).

• Delegation Oversight

• Develops metrics and reports to monitor the effectiveness of the D-SNP program,
  evaluating D-SNP program initiatives to improve performance, and recommending
  adjustments as necessary.
• Ensures vendor deliverables meet CMS standards.
• Supports development and maintenance of the Model of Care (MOC) by aligning
  vendor capabilities (e.g., case management, HRA completion, care coordination).

• Operational Integration

• Partners with DSNP Operations, Compliance, and IT teams to monitor data
  exchange and reporting accuracy (e.g., encounter data, care coordination files, etc.).
• Supports readiness for AEP and ongoing operations through vendor readiness
  assessments.
• Monitors vendor-related STARs, quality, and member experience metrics.

Qualifications

Education and Experience

Bachelor's degree in healthcare administration, Business, or related
field required. 5+ years of experience in Medicare Advantage or DSNP
operations, with at least 3 years in vendor management; or 6 years of
equivalent education and experience. Strong understanding of CMS
regulations, Medi-Cal, and SNP Model of Care requirements.
Experience managing claims, enrollment, call center, and care
management vendors preferred. Background in delegation oversight or
compliance monitoring programs strongly desired. Experience standing
up a new health plan or DSNP product highly preferred. Familiarity
with CMS readiness reviews, mock audits, and AEP readiness cycles.

Special Skills, Licenses and Certifications

Excellent project management and organizational skills. Strong
analytical ability to interpret performance metrics and compliance data.
Effective communicator with ability to influence and negotiate across
vendor and internal teams. Knowledge of CMS reporting, submissions,
and audit protocols. Proficiency in Microsoft Excel, PowerPoint, and
vendor management systems. 100% of vendors meet contractual SLAs
and compliance requirements. Timely completion of quarterly vendor
reviews and annual oversight audits. Zero major findings during CMS
or state audits related to vendor performance. On-time remediation of
all vendor-related corrective actions

Performance Based Competencies

Ability to evaluate plan performance. Develop and execute strategic
business initiatives. Perform policy development and implementation
in the areas of Medicare and Medi-Cal. Conduct compliance and
regulatory-related research and analysis to support decision-making
and planning for major strategic initiatives. Communicate effectively,
both verbally and in writing. Perform Project Management activities.

Work Environment And Physical Demands

Ability to use a computer keyboard and other business machines. More
than 50% of work time is spent in front of a computer monitor. When
required, ability to move, carry, or lift objects of varying size, weighing
up to 35 lbs.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.

HIRING RANGE:

$118,518.94 - $154,074.63

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.