Health Plan Vendor Oversight Auditor (Hybrid in Troy, MI) - Health Alliance Plan

General Summary

This role is passionate about supporting the Vendor Management Office (VMO) as part of an effective Compliance program. The Compliance Program provides a framework to continually evaluate, monitor, and report performance and risk associated with subcontractors through a coordinated and consistent approach. This position is tasked with maintaining key vendor management data and documenting compliance review activities and findings. This role will be the key driver in maintaining internal regulatory governance and metrics around evaluation for subcontractors and other risk-identified vendors and ensuring annual audits and monitoring exercises are completed accurately, timely, and reported per the compliance audit plan. Serve as corporate compliance representative to the subcontractors.

Principle Duties And Responsibilities

• Identify regulatory risks, develop risk mitigation strategies, and document findings remediation through closure.
  • Based on reviews and audits, works collaboratively with the subcontractor to support the design and implementation of corrective action plans, education, standard operating procedures, and system improvements.
  • Help establish a consistent and repeatable process of subcontractor assessments and risk oversight.
  • Develop communications, as appropriate, to ensure processes and subcontracting regulatory policies are understood by internal and external stakeholder base.
• Provide strategic level thinking, subcontractor management leading practices, and continuous improvement ideas to ensure best in class processes.

Education/Experience Required

• Bachelor's degree preferred.
• In lieu of a degree, six (6) years of Health Plan operational experience may be considered.
• Minimum of three (3) years of experience working in a Managed healthcare organization or health system’s Risk function or 3rd Party Oversight.
• Strong communication, problem solving, decision making and organizational skills necessary.
• Strong relationship building and conflict management skills are required.
• Must be results focused with the ability to work in an autonomous environment.
• Experience working with Federal and State Health programs.
• Experience working with commercial insurance programs.