Vendor Management Lead; Registered Nurse

Become a part of our caring community and help us put health first

The Vendor Management Lead (RN) oversees vendor management operations from a market perspective, ensuring alignment with Humana’s clinical and operational standards. This role directs a team of RN professionals, fosters effective vendor and provider relationships, and drives resolution of clinical and operational issues to support quality care and compliance.

• Provide strategic leadership and guidance to the Senior Vendor Management Professional (RN) team, ensuring effective execution of vendor management initiatives in accordance with Humana’s policies and regulatory requirements.
• Oversee and optimize vendor relationships, including performance monitoring, compliance management, and the resolution of complex operational and clinical issues.
• Facilitate collaboration between Humana, vendor partners, and providers, ensuring clear communication channels and the successful implementation of market-based strategies.
• Support the review of clinical authorizations and ensure consistency with established guidelines for various levels of care, leveraging clinical expertise and best practices.
• Identify systemic gaps and process improvement opportunities across vendor partnerships, developing and implementing action plans to close gaps and enhance service delivery.
• Analyze market trends, operational data, and vendor performance metrics to inform decision-making and drive continuous quality improvement.
• Ensure adherence to privacy, security, and enterprise information protection protocols, escalating issues as appropriate and maintaining compliance with internal procedures.
• Mentor and develop team members, fostering a culture of accountability, collaboration, and professional growth.
• Participate in strategic planning, vendor selection, and contract negotiations as needed, ensuring alignment with organizational objectives and clinical standards.
• Represent the vendor management function in cross-functional meetings, audits, and enterprise initiatives.

• Active and unrestricted Compact license (RN) license required
• Prior experience in a healthcare or insurance setting
• 5 + years of Utilization Management experience
• 3 + years of vendor management and/or process or project management experience
• Demonstrated ability to define and track KPIs and/or service level agreement metrics and other measurable success criteria
• Proven verbal and written communication skills with the ability to interact effectively across all organizational levels
• Ability to break down complex problems into actionable steps
• Demonstrated critical thinking and analytical problem-solving skills
• Exceptional relationship management skills
• Demonstrates accuracy and thoroughness, identifies process improvements
• Proficient in Microsoft Office applications including Word, Excel and Power Point
• Advanced facilitation skills with experience leading cross-functional discussions

• Master's Degree
• Knowledge of claims processes
• Knowledge of Stars and HEDIS
• Knowledge of clinical quality benchmarks and reporting requirements for value base providers
• Certification with Six Sigma and/or the Project Management Institute
• Knowledge of Medicare Advantage
• Grievance and Appeals experience

• This position will require 5-15% travel within the market.

• Must have the ability to provide a high-speed DSL or cable modem for a home office.
• Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information for you pertaining…