Vendor Oversight Manager

Minnetonka, MN

Humera is seeking a Vendor Oversight Manager for our client, a large health insurance provider, located in Minnetonka, MN. The individual in this role will oversee the client's contracted vendor’s compliance consistent with Centers of Medicare and Medicaid Services (CMS) requirements, National Committee for Quality Assurance (NCQA), Office of Inspector General (OIG) guidance for an effective compliance program and applicable State requirements. The incumbent is accountable for coordinating and collaborating with internal and external stakeholders to meet program objectives. This is a long term contract opportunity.

Duties

Management and Leadership of Vendor Oversight Program - 70%

  • Maintain and lead the delegated vendor oversight Program in accordance with regulatory and accreditation standards.
  • Develop and execute annual auditing and monitoring plans that fulfills CMS, DHS, NCQA and state regulatory requirements. Manage implementation of corrections actions as necessary to meet expectations.
  • Manage and chair the Delegated Vendor Oversight Committee (DVOC). Ensure monitoring activities and written audit reports are presented to DVOC for review and consideration.
  • Oversee annual delegation audits focusing on applicable delegated functions.
  • Collaborate with business partners to manage and enhance the excluded entity process for entities excluded from participation in Federal or State programs.
  • Collaborate with business partners to review and document substantive analysis of reports received for high risk vendors.
  • Collaborate with internal partners to develop and execute annual scorecards and questionnaires to monitor and manage key Medicare requirements relating to FDR oversight.
Prepare and Manage MDH Audit Project - 20%
  • Lead Copmany-wide audit of the MN Department of Health (MDH)/ Department of Human Services (DHS) Triennial Quality Assessment.
  • Develop tools to manage audit preparations and communicate status of those preparations to impacted leadership.
  • Lead business units to collect all documentation required to support a successful audit
  • Work with business leads to identify risk areas and appropriate remediation actions.
  • Collaborate with business units to develop corrective action plan (CAP) that meets MDH/DHS approval. Manage CAP for completeness, accuracy and gather evidence from business units.
Communication and Training - 10%
  • Provide routine delegation oversight reports to the VP of Compliance and Privacy for delivery to senior management.
  • Develop and administer communication plan to notify appropriate first tier entities of required training, code of conduct and compliance reporting protocols upon contracting and annually thereafter

Requirements

MINIMUM QUALIFICATIONS/REQUIREMENTS

  • Minimum education level required to qualify for the position: Bachelor’s degree or 7 years of health care experience
  • Major (only if required): Business Administration or Health Care Administration
  • Minimum years’ experience required in the field to qualify for the position: 5 years
Specific types of experience or skills required:
  • Advanced leadership skills
  • Minimum of five years of experience managing MDH/DHS audits
  • Knowledge of health care industry/products/benefits
  • Experience in risk analysis, auditing and monitoring
  • Knowledge of State and Federal regulations related to Medicaid programs
  • Project management and process improvement methodologies experience
  • Problem-solving capabilities and in-depth knowledge and experience in operations
  • Understanding of regulatory environment and compliance program guidelines

Post Date: 04.18.2019

Salary: Contact for Rate

Shift: 1st

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If you would prefer to speak directly to a Humera Staffing Consultant, please call us at 612-977-1440 and reference OrderID 816443


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For more than 45 years you may have known us as Dolphin Staffing - a name synonymous with quality temporary, and direct hire employment in the Minnesota. Today we are Humera - a boutique staffing agency that specializes in the placement of the best and brightest administrative and professional talent for contract, contract to hire and direct hire opportunities. Although we have changed our name, we continue to provide flexible career opportunities across a broad range of industries and with companies large and small. We invite you to become part of our elite workforce today!

Humera Administrative and Professional Staffing is an Equal Opportunity Employer.