Medicaid Clinical Vendor Management & Program Delivery Lead


  • Humana • Portsmouth, NH 03801

Job #1666164804

  • Description

The Vendor Management Lead works as liaison between vendors and organization. The Vendor Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial.


The Clinical Vendor Management & Program Delivery Lead reviews and negotiates terms of vendor contracts and communicates with vendors regarding day-to-day matters. Builds and maintains positive relationship with vendors and monitors vendor performance. Researches invoice and contractual issues and resolves discrepancies. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision. Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Detailed Job Responsibilities include:

  • Leads Clinical Operations in identifying and delivering Medicaid services and products to address strategic initiatives;
  • Administers operational process delivery for National clinical vendor pilots and partnerships;
  • Works closely with Medicaid’s Vendor Management contracting team to procure contracts and support relationships with vendors and partners;
  • Identifies and documents operational policies, process and workflows with vendors; submits IT business requirements, and develops training content for clinical teams;
  • Supports Director of Clinical Vendor Program Delivery in identifying best in class clinical partnerships, capabilities, and vended solutions to support industry-leading capabilities for Medicaid population;
  • Works closely with Medicaid Business Development, National and Medicaid Market Operational leaders, and Vendor Contracting team to identify clinical products and solutions;
  • Determines detailed business requirements, operational workflows, business area reporting, service level standards, and processes; works with vendors and internal partners to implement and support delivery of products and services;
  • Collaborates with Population Health Strategy team, Analytics, and Quality teams to establish reporting requirements, measures of success, and test pilot assumptions;
  • Leads operational clinical vendor implementations, provides oversight of effectiveness studies and recommends program changes needed to optimize health outcomes;
  • Monitors and supports ongoing decision making around scaling clinical solutions across Medicaid markets.

Required Qualifications

  • 3+ years of Clinical Product Management or Clinical Vendor Management experience
  • 2+ years of Medicaid experience
  • Demonstrated experience with implementation of large scale enterprise projects, pilot oversight, and/or development and leadership of collaborative partnerships with enterprise cross-functional teams and external partners.
  • Implementation experience within a large metric-intensive operational unit
  • Established experience with determination, analysis, and monitoring of vendor performance expectations; creating an accountability structure for vendors; and communicating vendor performance to key stakeholders
  • Demonstrated experience and recommendations from peers as a customer-focused, team player, with collaborative approach to leading
  • Proficient in Microsoft Office applications including Word, Excel and PowerPoint
  • Strong verbal and written communication skills
  • Strong facilitation and project management skills

Preferred Qualifications

  • 3+ years of Clinical industry or Managed Care organization experience with progressive leadership experience
  • Knowledge of and experience with state and federal Medicaid regulations or contracts
  • Vendor management or project management experience that interfaces with quality and/or accreditation standards
  • Master’s Degree
  • Certification with Six Sigma and/or the Project or Product Management certification
  • Clinical licensure (RN)

Additional Information

This position is open to working remote. (with the ability to work and support in the Eastern Time Zone)

Scheduled Weekly Hours



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