This role is responsible for the end-to-end management of Medicare vendor relationships, including contracting, implementation, performance oversight, and optimization. The position partners cross-functionally to ensure vendor-delivered benefits meet regulatory requirements, achieve targeted financial outcomes, and support a high-quality member experience across multiple markets. Organize and maintain open lines of communication with internal and external customers to ensure that product information is up-to-date and accurate.
- Lead vendor onboarding, implementation, and ongoing relationship management in partnership with MA&R and internal stakeholders
- Monitor and enforce contractual service level agreements (SLAs), ensuring vendors consistently meet performance expectations
- Serve as the primary point of contact for vendor issue resolution, escalating and driving timely remediation
- Collaborate with Procurement and implementation team on vendor contracting, including scope development, negotiations, and execution
- Ensure contract terms align with operational, financial, and regulatory requirements
- Maintain oversight of contract compliance and performance provisions
- Partner with Actuarial, Advanced Analytics, and Clinical teams to evaluate vendor cost performance and return on investment
- Support development of business cases, cost-benefit analyses, and ongoing financial monitoring
- Identify opportunities to optimize value and cost efficiency across vendor programs
- Work closely with internal teams including Medical, Analytics, Actuarial, Marketing, and Product to support benefit design and execution
- Support implementation and ongoing management of vendor-supported benefits across future expansion states
- Participate in Medicare Advantage bid cycle activities, including:
- Reviewing Plan Benefit Packages (PBPs)
- Supporting development of bid-related materials
- Participating in cross-functional bid review meetings (monthly, quarterly, and annual cadence)
- Support CMS regulatory reporting requirements related to vendor-delivered benefits
- Partner with Marketing to develop and maintain:
- Member-facing benefit communications
- Sales materials and sell sheets
- Ensure accuracy and compliance of all vendor-related benefit descriptions
- Identify and evaluate new vendor solutions and emerging capabilities to enhance benefit offerings
- Drive innovation initiatives to improve member experience, outcomes, and competitive positioning
- Recommend enhancements based on performance data, market intelligence, and internal priorities
Required
- Bachelor's Degree or equivalent in health care of business
- 5 years of relevant experience in managed care
- Solid understanding of the senior market and Medicare regulations
- Familiarity with state and federal regulatory and legislative processes required; must be able to read and interpret complex statutes and regulations.
As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here.
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids
Department Name
Product Administration Medicare - PH Managed Benefits
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8:00 a.m. to 5:00 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.
An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
