Clinical Vendor Program Manager IV

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Vendor Program Manager role is responsible for the vendor oversight and delivery of a delegated Utilization Management program. This role works closely with the Clinical Vendor Oversight Manager to ensure compliance with contractual obligations, regulatory requirements, and organizational standards. The Clinical Vendor Program Manager serves as the primary liaison between the organization and the Utilization Management vendor driving performance, quality, and affordability initiative success to meet and support Medica’s mission, vision and desired outcomes.

Performs other duties as assigned.

• Vendor Oversight and Compliance
  • Act as the main point of contact for the vendor relationship to support a delegated clinical program and affordability initiative
  • Vendor Performance & Accountability
    • Monitor vendor adherence to contractual terms, maintain service level agreement (SLA) documentation and budget management
    • Identify opportunities within the program and implement corrective action and remediation plans when necessary
  • Partner with Clinical Regulatory Oversight Program Manager to maintain regulatory compliance and deliverables
  • Ensure timely submission of reports and deliverables as outlined in Statements of Work (SOW)
• Manage cross-functional relationships between IT and Business Partners to include but not limited to:
  • Provider Network, Internal Utilization Management, Provider Data and Eligibility Teams, Claims, Customer Service and Account Management to support program success
• Oversee affordability measures and outcome monitoring
• Drive regular meetings with vendors and internal stakeholders to ensure program success
• Facilitate complex conversations with vendors to achieve Medica's desired outcomes
• Provide updates to leadership on vendor performance, risks, and mitigation strategies

• Bachelor's degree or equivalent experience in related field
• 7+ years of related experience beyond degree

• Experience in vendor management, and clinical delegated vendor oversight strongly preferred
• Computer proficiencies including Microsoft Office (Word, Excel, Access, Outlook, Visio, One Note, etc.) and experience with others.
• Ability to lead and be a good role model, influence change, shape and initiate work with colleagues across the organization and external (care systems, community collaborations, and vendors) to achieve department goals
• Ability to provide leadership based on teamwork, commitment & creative linkages with organizational business units, external vendors and care system representatives
• Excellent written and verbal communication skills with all levels of the organization
• Managing/Delegating/Measuring Work:
  Ability to develop appropriate objectives, accountabilities and measures. Ability to monitor and report progress; identify and address barriers
• Quality Focus:
  Commitment to continuous quality improvement in all aspects of work. Skilled user of quality tools and techniques
• Experience setting expectations and direction for delivery by the team

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations:
Minnetonka, MN, or Madison, WI.

The full salary grade for this position is $88,800 - $152,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $88,800 - $133,245. Annual salary range placement will depend on…