Vendor Compliance Manager

MedImpact Healthcare Systems - San Diego, CA (30+ days ago)3.4


The Vendor Compliance Manager ensures the oversight and administration of vendors including subcontractors delegated to perform certain services on behalf of MedImpact and its subsidiaries (the “Organization”), vendors classified as downstream entities or other classifications by regulatory agencies or accrediting bodies. This position works in partnership with cross-functional business owners (relationship managers), Procurement, Regulatory Compliance and Contract Management.

Essential Duties and Responsibilities include the following. Other duties may be assigned.
  • Develops and documents the strategy plan and methodology to ensure the Organization’s compliance with contractual and regulatory performance of its vendors
  • Assesses and documents each identified vendor’s adherence to contracts, work standards, and regulatory requirements, including applicable Centers for Medicare and Medicaid Services (“CMS”) rules and guidelines, Office of Inspector General (“OIG”) or other regulations as defined
  • Develops and maintains a schedule of vendor events/milestones (e.g. annual audit dates, monthly OIG/GSA screens, requests for certificates of insurance etc.)
  • Monitors changes in the regulatory or URAC/NCQA accreditation environment impacting the Organization and its delegated functions
  • Conducts impact analysis of new or changed client contract obligations or regulations on existing policies with the applicable business owner and implements new or modified internal policies and procedures as a result
  • Participates in the CMS Guidance meetings as well as other committees or work groups that evaluate regulations that may impact the Organization’s oversight of vendors
  • Provides information on organizational vendor oversight process and subject matter expert support to internal and external client support (ECS)
  • Serves as the primary contact for internal and external auditors and regulators as necessary to articulate organizational oversight of the Organization’s delegated functions
  • Drafts formal communications documenting (1) findings from audits, (2) expected corrective actions required, (3) and contractual obligations to be distributed internally to relationship managers and externally as a formal corrective action plan
  • Incorporates oversight of corrective action plans and associated milestones in ongoing vendor oversight work plan
  • Chairs the Subcontractor Review Work Group which is established to evaluate vendors servicing the Organization’s Part D, Medicaid and Marketplace functions for First Tier, Downstream or Related Entity (FDR) status
  • Partners with the Procurement team to identify potential Medicare Part D, Medicaid and Marketplace vendors prior to contracting and ensures a (First Tier Downstream Entity) FDR status determination is performed by the Subcontractor Review Work Group
  • Communicate results of FDR status determination to Contract Management and educates the internal Business Owner/Relationship Manager of the FDR oversight expectations and pre-delegation assessment requirements as warranted
  • Establishes communication plans with relationship managers to ensure that vendors understand and meet the requirements set forth by contractual, legislative and regulatory bodies
  • Maintains a master list of contracted vendors, including the Organization entities utilizing them, a description/scope of services they perform, line(s) of business and the designated relationship managers
  • Maintain a master list of clients and the vendors that the Organizes uses
  • Develops and maintains policies and procedures related to the oversight process of vendors
  • Develops and provides training to relationship managers on vendor oversight, including assistance with the implementation of oversight processes
  • Supports the relationship managers in the formulation of appropriate metrics to monitor performance of contracts
  • Documents information and activities for use with education of staff and/relationship managers on regulatory requirements and business impact of guidance
  • Continually evaluates opportunities for improved process, policy, and operational efficiency and consistency
  • Leads standards review process on a quarterly (or more frequent basis) with relationship managers to ensure proper prioritization, dissemination, and communication of oversight efforts
  • Liaises with relationship managers/internally and externally to build compliant functions, serves as a resource and provides management oversight of delegated functions such as timely reporting of service level agreements, performance guarantees and delivery/execution of annual compliance certifications
  • Serves as a liaison between MedImpact and cross-functional areas for process and policy development
  • Performs random and periodic quality control checks for adherence with guidelines; provides written and verbal analysis of results to applicable internal stakeholders
  • Supports the client Request for Proposal (RFP) process by coordinating information and tasks with other company management, drafting business requirements, and ensuring coordination with contracts manager
  • Participates in the vendor bid process with the Procurement team
  • Provides guidance and mentoring to less experienced members in the department including department intern roles (i.e., Summer Interns)
  • Initiates attendance at job related trainings, industry meetings to keep up to date with best practices
Education and/or Experience

For consideration, candidates will need a Bachelor’s Degree from a four-year college or university (or equivalent combination of education and experience) along with seven (7) plus years’ work experience in a managed care, health plan, PBM, or a medical environment required (of which two (2) plus years should include working in a comparable vendor management capacity). Candidates must have a good working knowledge of delegation oversight regulations as outlined in the Medicare Prescription Drug Benefit Manual, Third Party Relationships (Delegated Agreements), and other regulators. CMS, Medicare Part D, Medicaid and Marketplace experience is preferred.

Computer Skills

To perform this job successfully, an individual must be proficient in Microsoft Office (Access, Excel, Word, and PowerPoint). Experience with Microsoft Project and Compliance 360 a plus.

Other Skills and Abilities
  • Ability to handle multiple, complex tasks, and responsibilities simultaneously, often under tight timelines
  • Ability to identify and define organizational needs and develop a solution, system, or process to meet the need
  • Ability to monitor, identify, assess, and articulate changes in applicable regulatory requirements
  • Good communication skills including written, verbal as well as demonstrated presentation skills communicating with diverse audiences
  • Strong interpersonal skills, with demonstrated ability to lead and contribute to a team effort
  • Strong analytical and critical thinking skills as well as ethics and integrity
  • Detail oriented with good documentation skills and with excellent organizational and time management skills
  • Able to work effectively in a fast-paced, dynamic environment
  • Demonstrated experience with effective time management working with minimal supervision and successfully handling multiple projects simultaneously, prioritizing work appropriately
  • Experience working with all levels of staff
  • Demonstrated initiative in organizing and prioritizing work to meet deadlines
This position is eligible for Employee Referral Bonus at Level II

EOE, M/F/D/V

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.