Medical Management Vendor Relations Analyst

Job description

#LI-Hybrid - Coordinate 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 involvement - Presents vendors' UM program description, program evaluation, and delegation oversight audit reports to HMSA's cross-functional committees - Meets regularly with vendor's operational areas to assist...