Medical Management Vendor Relations Analyst

Job DescriptionCoordinate and manage deliverables of aspects of utilization management programs by delegated vendors:Ensures that program deliverables, documentation, and reporting are complete and meets contractual, compliance, and accreditation requirements. Develops data templates and submission forms.Maintains program documentation for auditing purposes.Analyzes business issues, including but not limited to new services, contract deliverables, enhancements, etc.Troubleshoots workflow issues as well as member/provider complaints and recommend solutions to management and internal departments.Reviews status reports to ensure projects progress on schedule within prescribed guidelines. Modify plans as required. Prepares project reports for management, partners, or others as required.Identifies and implements opportunities for process improvement in workflows and infrastructure operations. Initiate change and evaluate impact.Program interaction/Committee involvementPresents vendors' UM program description, program evaluation, and delegation oversight audit reports to HMSA's cross-functional committeesMeets regularly with vendor's operational areas to assist with oversight of the vendor program and servicesProvides coordination and guidance to other departments and external resources in managing work to support efficient program operations.Leads coordination of internal cross-departmental meetingsProvides training and consultation to vendor staff on an as-needed basisSubject matter expertise on program complianceFacilitates quarterly UM file reviews with Medical Director's guidanceActs as a liaison between vendors and HMSA departments for various audit activitiesCoordinates with vendors to ensure timely and accurate reporting of UM decisions as required by state and federal agenciesProvides subject matter expertise in evaluating vendors' compliance with NCQA UM standardsPrepares vendors' documentation in consultation with Quality Improvement department for submission to NCQA during re-accreditation surveysPerforms all other miscellaneous responsibilities and duties as assigned or directed#LI-HybridJob RequirementsBachelor's degree and three years of work experience or equivalent combination of education and experience.Working knowledge/skills in project management/coordinationWorking knowledge in issues identification, data collection, and validationStrong oral and written communication skills with the ability to provide information to management, providers, vendors, and other employees.Basic working knowledge in Microsoft Office applications, including Word, Excel, and Outlook.Working knowledge of database and spreadsheet programs.Job DetailsJob Type: Full-timeCategory: Analyst