Advanced Search


Start New Search:

nyc health hospitals
elmhurst hospital
non profit organizations
post acute care
intake coordinator
vendor relations
government relations
political science
healthcare administration
strategic partnerships
on demand
public administration
labor relations
care manager
vendor management
public affairs

Vendor Relations Manager

Share Job
Suggest Revision
MetroPlus Health PlanNew York, NY
  • $65,000 - $70,000 a year
  • MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  • As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus’ network includes over 27,000 primary care providers, specialists and participating clinics.
  • For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • Vendor Relations Manager: Responsible for implementing, maintaining, and monitoring the relationships with MetroPlus’ contracted High Dollar Review and Special Investigations (SIU) Vendors in order to best meet MetroPlus’ corporate and regulatory goals; Provide management of vendors in accordance with MetroPlus policy and regulatory requirements; Manage various communications, focused projects, and ongoing work efforts and coordinate their completion with MetroPlus departments and Vendors.
  • Be the main point of contact for two vendors: One that is responsible for coordinating investigations into potential fraud and abuse by network providers; and one vendor that is responsible for reviewing medical records to determine if high dollar claims are appropriately billed and coded.
  • Both vendors serve a need for containing plan costs and eliminating unnecessary costs in payment for healthcare services.
  • Analysis of monthly reporting, specifically for High Dollar and Special Investigation Units.
  • Assess any areas where improvement may be needed, or where MetroPlus and the contract goals are not being met.
  • Work with the Manager to implement and follow through with corrective action plans as needed.
  • Set priorities, monitor performance and develop analytical and financial reporting of vendors including routine scorecards and agreed upon KPI’s.
  • Serve as a central point of contact between MetroPlus internal areas and the vendor.
  • Assist in coordination of regulatory responses, audit, claim requests and other MetroPlus needs as required.
  • Address day to day issues related to the Vendors and work with internal partners (Claims, Finance, and Operations etc.)
  • to resolve issues in a timely manner.
  • Perform as go-between for external vendors and internal stakeholders.
  • Identify improvement areas internally as well as perform closely with all internal stakeholders to prepare solutions.
  • Identify cost improvement opportunities and develop and maintain strategies that conform to the management of overall medical costs.
  • Track cost savings from each vendor.
  • Coordinate between MetroPlus internal areas and the vendor to monitor open cases and audit activities to extract files and process as appropriate
  • Identify and implement continuously enhance efficiencies associated with vendor management for SIU and High Dollar vendors.
  • Participate to formulate workflow processes, methods and policies for applying vendors.
  • Stimulate steady process enhancement to present increasing operational efficiency in entire business partner processes.
  • Support to explore expansion across new business lines and products and make recommendations regarding potential opportunities and appropriateness.
  • Support updating applicable processes and procedures.
  • Assist in training to ensure appropriate processes and procedures are communicated and properly followed.
  • Ability to pull reports, scrub and analyze data, and present it in a clear and meaningful manner.
  • Oversee monitoring of vendor performance against contractual obligations to ensure overall effectiveness of vendor provided services with the utilization of vendor performance dashboards, scorecards and/or report
  • Proactively engage with corporate departments to support initiatives and strategies associated with key metrics for the unique partnership and the growth of the partnership.
  • Be able to work with Managed to identify Return on Investment (ROI) for specific vendor relationships and capture the value that each vendor brings to MetroPlus.
  • 3-5 years vendor management experience with at least 2 years of benefit configuration and claims processing and adjudication experience.
  • 1-2 years of managed care experience including Enrollment and Claims processing platforms
  • Bachelor’s Degree in Finance, Accounting, Business, Health Care Management, Information Technology or other similar area, highly preferred.
  • Background or Certification in Healthcare Coding preferred
  • Ability to work independently with minimal supervision
  • Background in provider and facility claims – understanding of health care coding and claims processing.
  • Understanding of health plan payment methodologies and reimbursement for different types of services
  • Competent at relationship-building.
  • Focuses on understanding the needs of the Plan and getting the best possible results
  • An ethic of service, an understanding and anticipation of a Plan’s changing business needs
  • Comfortable working as a team lead and training colleagues as needed
  • Ability to document business processes and create policies which are compliant with CMS requirements
  • The ability to manage stress and conflict, keeping composed and acting as a mediator when conflicts arise
  • Using interpersonal and communication skills to network in an effective way
  • Sensitive to changing personal demands and requirements and changes accordingly
  • Uses his/her time effectively and efficiently
  • Good analytical skills and ability to prioritize diverse responsibilities
  • Proven ability to learn appropriate software
  • Effective problem solving, and analytical skills are required with the ability to evaluate demands on time
  • Problem-solving, including other stakeholders
  • Operations – logistics, processes, integration
  • Communications – explanation, meetings, negotiation
  • Business and financials –analysis, forecasting,
  • Project management – by timelines, milestones and deliverables
  • Business and financials –analysis, forecasting, ROI, savings
  • MetroPlus Health Plan - Today
  • Get job updates from MetroPlus Health Plan
  • Since 1985, MetroPlus Health Plan, Inc., a prepaid health services plan, has been offering low or no-cost quality health insurance to eli
  • Let employers find you
  • Let Employers Find You

Similar jobs:

  • All Jobs
  • Active
Vendor Relations Representative
Legacy Group Enterprises IncNew York, NY
Job Purpose:The purpose of this role is to act as a liaison between operations personnel, accounting personnel, and vendors.
Associate Executive Director of External And Government Relations
MetroPlusNew York, NY
About NYC Health + Hospitals
$200 - $250
LOA Intake Coordinator Personnel / Labor Relations Associate, HR Leave Administration
NYC Health & HospitalsNew York, NY
About NYC Health + Hospitals
Accountable Care Manager
NYC Health+ HospitalsQueens, NY
About NYC Health + Hospitals
Vendor Relations Specialist
NuSourcesNew York, NY
Title: Senior Vendor Relations Administrator
How do Good Interviewers Prepare for Interviews?

Just like candidates take the time to research you and your company, you should take the time to prepare for the interview. Preparing for the interview doesn't just reflect well on your employer brand and create a better candidate experience. Preparation also helps prevent bad hiring decisions. Bad hiring decisions are usually a result of poor execution during the hiring process. However, going into an interview fully prepared and ready to evaluate candidates will help avoid bad hires. So, here are 6 interview preparation tips for employers.

KIPP NYC Employee Relations Manager
Kipp NycNew York, NY
KIPP NYC Public Schools is a non-profit network of free, public charter schools that prepares students for success in college and life.
Vendor Relations Specialist
F. Schumacher & CoNew York, NY
F. Schumacher & Co., America’s leading name for interior design and manufacturing, distributing fabric, wall covering, floorcovering and furnishings, is seeking an outstanding, personable, proactive, and flexible administrative professional to act as our Administrative Assistant.
KIPP NYC Employee Relations Manager
KIPPNew York, NY
Company DescriptionKIPP NYC Public Schools is a non-profit network of free, public charter schools that prepares students for success in college and life.
Care Manager (UM)
MetroPlusHealthNew York, NY
About NYC Health + Hospitals
How to Conduct a Performance Review (With Examples)

In a world where the smallest mistake can cost your business tens of thousands in lost revenue, your talent is key to keeping your edge on the market and driving growth. However, managing a workforce of any size can be a challenge. Employees come with their own particular skill set, ambitions and flaws. So, it can be difficult to uncover their individual drivers. Not to mention the challenges brought on by the hybrid and remote working models where in-person interactions have become few and far between.

Office / Vendor Manager
Northbound Executive SearchNew York, NY
Our client, a well-established Hedge Fund in New York, NY is looking for an Office/Vendor Manager to join their team We are seeking individuals that can work in midtown Manhattan NYC on a remote-hybrid schedule.
Vendor Risk Manager
Selby Jennings BuysideNew York, NY
A top Alternative Investment Firm with over $50 billion in AUM is looking to build out its Third-Party Risk team in NYC. The firm is a leading credit fund and focuses mostly on securitized products, structured products, and corporate credit.
Global Vendor Relations Manager
Elsevier IncNew York, NY
About the RoleIn this role you will own the vendor strategy for engineering and life science solutions.
Vendor Risk Manager
Jobs via EFinancialCareersManhattan, NY
A top Alternative Investment Firm with over $50 billion in AUM is looking to build out its Third-Party Risk team in NYC. The firm is a leading credit fund and focuses mostly on securitized products, structured products, and corporate credit.
How to Recruit Passive Candidates

Learning to recruit passive candidates is a different ballgame than recruiting active ones. While an active candidate is someone who is currently looking for a new job, a passive candidate tends to be the opposite. Passive candidates are either already working or not looking to work. So, instead of these candidates coming to you, you'll have to find them and reach out to them first.

Product Manager, Marketplace Products
MetroPlusJersey City, NJ
About NYC Health + Hospitals
Bronx Community Relations Manager
Good Shepherd ServicesNew York, NY
NOTE: As a NYC contracted agency all positions at Good Shepherd Services fall under the NYC vaccine mandate.
$41,000 - $70,000 a year Full-time

Latest Blog Posts: to Effectively Recruit EmployeesToday, hiring and retaining talent looks much different than it did only two or three years ago. Financial instability and the strain on our mental health brought on by the pandemic has made everyone more wary and selective of their workplace and employer. Whereas in the past people might have prioritized promotions and financial reward, today they look at other factors such as workplace flexibility, personal fulfillment and values alignment. Many Hours is Part-Time vs. Full-Time Work?Growing up you watched your parents shuffle to and from the office, held hostage to their 9 to 5. If jammed-packed schedules and deadlines sound frightening, you might consider pivoting your search to part-time jobs. In fact, even employers have shifted their preference, selecting more people open to the idea of flexible working hours. to Make a Job Offer More CompetitiveMoney alone makes it hard to attract and retain top-notch candidates, especially when you are competing with larger businesses and corporations in your industry. So, instead of focusing on money, figure out how to make a job offer more competitive when you can't offer more money. Ways to Stretch Your Hiring BudgetMany businesses across the country have adjusted business operations to make it through the pandemic. After a period of hardship, many business owners, like yourself, are ready to start recruiting and rebuilding a bigger, more skilled workforce - only now you have to do it with a smaller hiring budget. to Ask for a Raise at WorkHere we go again; it’s time to talk money. Whether you’re one year in at a new company or approaching year five on the same team, learning how to ask for a raise should be part of your long-term career plan. These conversations are rarely fun (thanks to society, which has conditioned us to believe that money is taboo), but they are necessary if you want to, well, get paid what you’re worth. Trust us, there’s a lot of money on the table for taking. Below, we’ll discuss tips on timing, approach, and follow-up. in the Workplace: How to Improve your HR Function with AIIt’s safe to say that the last two years have brought fundamental changes to the way we work and do business. Companies have relied on technology in the workplace to digitize their services and build a remote-friendly infrastructure that could prepare them for the future. Job Titles for Entry, Mid, and Senior-Level PositionsAn operations team can take on many functions within a business. With wide-ranging responsibilities come wide-ranging job titles. This means that you have to be more vigilant in your job search. On one hand, the perfect job might be hidden under a title you might not expect. Meanwhile, operations titles that you’re used to looking at may mean something different at a given organization depending on their structure.