Vendor Management and Oversight

Job Title: Vendor Management and Oversight Job ID: 26-03055 Location: Grand Rapids, MI Duration: 03 months on W2 contract

Must Have: Healthplan experience in claims adjudication, specifically in Payment Integrity

Specific Skillset Requirements:

This role is responsible for the oversight and management of vendor relationships and associated contracts to ensure alignment with business systems, organizational goals, regulatory requirements, and financial targets. Key responsibilities include monitoring vendor performance against systems, contractual obligations and service level agreements (SLAs), ensuring compliance with healthcare regulations and internal policies, and identifying opportunities for cost containment and operational efficiency. The position partners cross-functionally with payment integrity teams to evaluate vendor deliverables, mitigate risk, and support contract recommendations and alignment. This role also drives accountability through performance reporting, issue resolution, and continuous improvement initiatives to optimize vendor value and support high-quality member outcomes.

Expenses allowed: To be decided.

Client Equipment to be Provided.

Job Summary:

Responsible for the strategy, development and management of the product suite. Partners with upline to proactively identify market opportunities and guides others through the implementation of new products. Monitors and maintains product portfolio, providing direction for next steps in the product lifecycle. Providing effective status reporting, issue escalation, risk mitigation and program decision making throughout the life cycle of the program. Competent to work at the highest levels of all phases of project leadership. Regularly provides guidance, direction and training to less experienced staff.

Essential Functions:

• Serves as department resource and mentor to assist in the professional development and continuing education of team. Assists in selecting, training, developing and evaluating.
• Drives progress, achieving expected business outcomes, with effective: status reporting, issue escalation, risk mitigation and program decision making.
• Oversees complex projects/programs with appropriate departmental and leadership relationship management, and project management. Responsible for the management of multiple projects: Develops project plans, budgets and schedules. Coordinates project work, and completes projects on time and within budget. Works with/leads the constituent Project Managers/work group leads responsible for the execution of their areas of a project to monitor cost, schedule and technical performance of component project and operation, while working to ensure the ultimate success of the program.
• Organizes and works with appropriate leadership, departments and leaders to plan and schedule the coordination of people and tasks as needed to accomplish project objectives. Appropriately manages vendors from initial contracting through project completion. Serves as the leader for assignment of work activities, escalation of project related issues, service delivery, and customer satisfaction. Able to coordinate activities of numerous, diverse areas simultaneously.
• Acts as project leader on the most complex special projects utilizing project management and technical computer skills to ensure all project activity is completed in an accurate timely manner including RFP's, RFI's, consolidations and conversions.
• Responsible for the management of product lines which includes, but not limited to:
  • Analysis of product positioning and pricing in the market
  • Knowledge of competitor products, pricing and offerings
  • Development of strategies and oversight of tactics
  • Monitoring of business outcomes
• Recommend product offerings, conducting competitive market analysis to ensure Priority Health plans are at the cutting edge
• Lead cross functional teams through implementation of product design.

• Required Bachelor's Degree or equivalent in health care or business
• 7 years of relevant experience in product development lifecycle Required
• Strong knowledge and understanding of health care products, benefit structures, and product development process Required
• Familiarity with state and federal regulatory and legislative processes required; must be able to read and interpret complex statutes and regulations Required
• Ability to quickly grasp and describe health plan products and benefit designs Required