Manager of Vendor Oversight

Responsibilities

• Vendor Management: Leads the implementation and onboarding of key DSNP vendors. Works with internal business partners on the management of vendor Service Level Agreements (SLAs) and Key Performance Indicators (KPIs). This includes receiving vendor reports, arranging and attending Joint Operations Meetings (JOC), reviewing, and documenting vendor performance and working with Compliance to assess corrective action plans (CAPs) where applicable. Collaborates with internal and external business partners on the collection, analysis, and maintenance of relevant data. Supports the development of plans and operational solutions to address changes to vendor programs on an annual basis. Develops vendor readiness plans, timelines, and deliverables aligned with CMS application and Annual Enrollment Period (AEP) launch milestones. Partners with Legal and Compliance on contracting to ensure inclusion of compliance and performance provisions. Establishes governance cadence — weekly stand-ups, monthly performance meetings, and readiness checkpoints. Leads day-to-day relationship management of delegated DSNP vendors. Conducts regular vendor performance monthly reviews and quarterly business reviews (QBRs). Ensures vendors adhere to operational timelines, data quality standards, and reporting requirements.
• Compliance and Regulatory Management: Supports Compliance and Regulatory teams to prepare for CMS and state readiness reviews, including submission of vendor documentation. Ensures that the D-SNP Program and related processes adhere to regulatory and contractual requirements, laws, accreditation standards, and regulations, including Medicare Advantage, Centers for Medicare and Medicaid (CMS), Department of Managed Health Care (DMHC), and the Affordable Care Act. Collaborates with Compliance, Quality, and Regulatory Affairs to ensure delegated oversight program meets CMS requirements. Reviews and validates vendor compliance attestations and documentation (policies, procedures, training, etc.).
• Delegation Oversight: Develops metrics and reports to monitor the effectiveness of the D-SNP program, evaluating D-SNP program initiatives to improve performance, and recommending adjustments as necessary. Ensures vendor deliverables meet CMS standards. Supports development and maintenance of the Model of Care (MOC) by aligning vendor capabilities (e.g., case management, HRA completion, care coordination).
• Operational Integration: Partners with DSNP Operations, Compliance, and IT teams to monitor data exchange and reporting accuracy (e.g., encounter data, care coordination files, etc.). Supports readiness for AEP and ongoing operations through vendor readiness assessments. Monitors vendor-related STARs, quality, and member experience metrics.

Qualifications

• Education and Experience: Bachelor’s degree in healthcare administration, Business, or related field required. 5+ years of experience in Medicare Advantage or DSNP operations, with at least 3 years in vendor management; or 6 years of equivalent education and experience.
• Strong Understanding: Strong understanding of CMS regulations, Medi-Cal, and SNP Model of Care requirements. Experience managing claims, enrollment, call center, and care management vendors preferred. Background in delegation oversight or compliance monitoring programs strongly desired. Experience standing up a new health plan or DSNP product highly preferred. Familiarity with CMS readiness reviews, mock audits, and AEP readiness cycles.
• Special Skills, Licenses and Certifications: Excellent project management and organizational skills. Strong analytical ability to interpret performance metrics and compliance data. Effective communicator with ability to influence and negotiate across vendor and internal teams. Knowledge of CMS reporting, submissions, and audit protocols. Proficiency in Microsoft Excel, PowerPoint, and vendor management systems.

Performance Based Competencies

• Evaluate plan performance. Develop and execute strategic business initiatives. Perform policy development and implementation in the areas of Medicare and Medi-Cal. Conduct compliance and regulatory-related research and analysis to support decision-making and planning for major strategic initiatives. Communicate effectively, both verbally and in writing. Perform Project Management activities.
• Work Environment And Physical Demands: Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs.

Important Disclaimer Notice

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.