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Provider / Vendor Relationship Manager - Medicaid
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- Master's degree in healthcare administration, business administration, law, public health, nursing, social work or related
- Six Sigma Green Belt Certification
- Coordinate all internal and external communication and processes for the vendor arrangement including but not limited to claims processing, audits, file transfers, utilization management (including appeals), network management, credentialing, enrollment, member relations, sales, marketing, reporting, information technology, etc.
- Ensure vendor is in compliance with BCBSA, BCBSAZ, AHCCCS, CMS, and NCQA guidelines and regulations
- Coordination of the delegation oversight as applicable for Utilization Management, Case Management, Network Management, Member Relations, Credentialing or other; follow-up with subject matter experts as needed; maintain applicable accreditation compliance
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