Talent.com
Henry Ford Hospital
Health Plan Vendor Oversight Auditor (Hybrid in Troy, MI) - Health Alliance PlanHenry Ford Hospital • Troy, MI, United States
Health Plan Vendor Oversight Auditor (Hybrid in Troy, MI) - Health Alliance Plan

Health Plan Vendor Oversight Auditor (Hybrid in Troy, MI) - Health Alliance Plan

Henry Ford Hospital • Troy, MI, United States
10 days ago
Job type
  • Full-time
Job description

Compliance Program Support

This role is passionate about supporting the Vendor Management Office (VMO) as part of an effective Compliance program. The Compliance Program provides a framework to continually evaluate, monitor, and report performance and risk associated with subcontractors through a coordinated and consistent approach. This position is tasked with maintaining key vendor management data and documenting compliance review activities and findings. This role will be the key driver in maintaining internal regulatory governance and metrics around evaluation for subcontractors and other risk-identified vendors and ensuring annual audits and monitoring exercises are completed accurately, timely and reported per the compliance audit plan. Serve as corporate compliance representative to the subcontractors. Develops and implements audit procedures, manages audit data, outcomes, and follow-up activities, and performs documentation and operational risk assessments to identify areas for process improvement. Drives implementation of the improvements to achieve efficiencies and eliminate redundancy. Responsible for development of reports, work instructions and work programs related to compliant audit processes. Identify risk areas or trends to be reviewed for audit plan and as needed, based on external focus areas, including identification of root causes. Works closely with leadership to promote and administer subcontractor audit activities.

Principle Duties and Responsibilities:

  • Identify regulatory risks, develop risk mitigation strategies, and document findings remediation through closure.
  • Based on reviews and audits, works collaboratively with the subcontractor to support the design and implementation of corrective action plans, education, standard operating procedures, and system improvements.
  • Help establish a consistent and repeatable process of subcontractor assessments and risk oversight.
  • Educate and consult business stakeholders in developing and continuously improving the understanding of subcontractor risk and strategies to mitigate it.
  • Execute locally, the global corporate standards to satisfy regulatory requirements around data privacy and sharing.
  • Interact directly with subcontractors, as needed, to ensure the appropriate information is gathered and assessed prior to onboarding approval.
  • Develop communications, as appropriate, to ensure processes and subcontracting regulatory policies are understood by internal and external stakeholder base.
  • Provide strategic level thinking, subcontractor management leading practices, and continuous improvement ideas to ensure best in class processes.

HAP Pay Grade: 26 (exempt)

Education/Experience Required:

  • Bachelor's degree preferred. In lieu of a degree, six (6) years of Health Plan operational experience may be considered.
  • Minimum of three (3) years of experience working in a Managed healthcare organization or health system's Risk function or 3rd Party Oversight.
  • Strong communication, problem solving, decision making and organizational skills necessary.
  • Strong relationship building and conflict management skills are required.
  • Must be results focused with the ability to work in an autonomous environment.
  • Experience working with Federal and State Health programs.
  • Experience working with commercial insurance programs.
Create a job alert for this search

Health Plan Vendor Oversight Auditor (Hybrid in Troy, MI) - Health Alliance Plan • Troy, MI, United States

Similar jobs

Vice President, Health Plan Analytics

ConfidentialDetroit, MI, United States
Full-time

Vice President, Health Plan Analytics.The Company is seeking a Vice President for Health Plan Analytics to lead the advancement of analytics and insights that support the organization's strategic g... Show more

 • Promoted

Director, Health Plan Provider Contracts (Medicaid / Michigan Health Plan) - Remote in Michigan

Molina HealthcareDetroit, MI, United States
Remote
Full-time

Leads and directs team responsible for health plan provider network contracting activities.Supports network strategy and development with respect to adequacy, financial performance and operational ... Show more

 • Promoted

Field Reimbursement Director

Glaukos CorporationDetroit, MI, United States
Full-time

Reimbursement Liaison Director.The Reimbursement Liaison Director's primary role is to facilitate the growth of Glaukos products by way of leading and coaching field-based reimbursement team member... Show more

 • Promoted

Auditor

CONTACT GOVERNMENT SERVICESDetroit, MI, United States
Full-time +1

Auditor Employment Type: Full-Time, Mid-Level Department: Financial CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations... Show more

 • Promoted

Medical Assistant (Clinical Partner)

HarmonyCaresTroy, MI, United States
Full-time

HarmonyCares Clinical Partner (Medical Assistant).HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs.Headquartered out... Show more

 • Promoted

Regional Medical Director - Governance

General MotorsWarren, MI, United States
Full-time

Medical Directors are responsible for either leadership and management of multiple Health Centers/complexes, or one or more global medical operations or programs.Other responsibilities include; per... Show more

 • Promoted

Sr. AD, Strategic Accounts - Oncology (MN, MI, WS, IN)

Boehringer IngelheimDetroit, MI, United States
Full-time

The Strategic Account Manager will uncover opportunities for utilization of approved BI oncology product and optimal clinical benefit in appropriate patients within Oncology-specific organized cust... Show more

 • Promoted

Associate Market Clinical Director - Detroit

ChenMedDetroit, MI, United States
Full-time

Associate Market Clinical Director.We're changing lives every day.For both our patients and our team members.Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the c... Show more

 • Promoted

Senior Auditor

CONTACT GOVERNMENT SERVICESDetroit, MI, United States
Full-time

Senior Auditor Employment Type: Full Time, Mid-level Department: Financial Services CGS is seeking a Senior Auditor who will assist the district legal staff by conducting medical claims data ana... Show more

 • Promoted

APP Manager, Pediatric Emergency - Troy/Royal Oak

Corewell HealthTroy, MI, United States
Full-time

Advanced Practice Provider Manager.Improve health, instill humanity and inspire hope.That's just the beginning of the difference you can make when you join our team at Corewell Health.Responsible f... Show more

 • Promoted

Home Health Clinical Director

Residential Home Health and HospiceTroy, MI, United States
Full-time

At Residential Home Health and Hospice ("Residential"), we're looking to add to our extraordinary care team.Grounded by our belief that outstanding care is best delivered in a team-based environmen... Show more

 • Promoted

Digital Health Strategist- Central Region

Exact SciencesDetroit, MI, United States
Full-time

Lead Digital Health Strategist.At Exact Sciences, we're helping change how the world prevents, detects and guides treatment for cancer.We give patients and clinicians the clarity needed to make con... Show more

 • Promoted

Director of Trauma

Veracity SolutionsDetroit, MI, United States
Full-time

Directs the personnel, operational and financial activities of the Department of Surgery Administration at Sinai-Grace Hospital (SGH).Ensures the Department of Surgery Administration has sufficient... Show more

 • Promoted

Internal Auditor - FT

MotorCity CasinoDetroit, MI, United States
Full-time

Job Category: Accounting / Finance Requisition Number: INTER001071.MotorCity Casino Hotel 2901 Grand River Ave Detroit, MI 48201, USA.Plan and conduct operational, financial, compliance, and intern... Show more

 • Promoted

Regional Business Director, Hematology/Oncology Great Lakes

SanofiDetroit, MI, United States
Full-time

Pursue Progress, Discover Extraordinary.Better medications, better outcomes, better science.But progress doesn't happen without people people from different backgrounds, in different locations, do... Show more

 • Promoted

Strategic Oncology Account Director - Great Lakes

GSKDetroit, MI, United States
Full-time

Strategic Oncology Account Director.The territory for this role includes Ohio, Michigan, and Indiana.GSK is a place to build a career in Oncology where purpose, science and growth come together.As ... Show more

 • Promoted

Auditor

Contact Government ServicesDetroit, MI, United States
Full-time +1

Employment Type: Full-Time, Mid-Level.CGS is seeking a highly skilled Auditor to provide general auditing and accounting services in support of fraud investigations involving potentially complex fi... Show more

 • Promoted

Associate Chief Clinical Officer, Troy Medical Campus - Michigan Medicine

AMN HealthcareTroy, MI, United States
Full-time

Associate Chief Clinical Officer.Michigan Medicine / University of Michigan Health, Troy, Michigan.Michigan Medicine seeks a dynamic, distinguished physician executive to serve as the inaugural Ass... Show more

 • Promoted

VP, Chief Medical Affairs (Henry Ford Health)

Shirley Ryan AbilityLabDetroit, MI, United States
Full-time

VP, Chief Medical Affairs (CMA) at Henry Ford Health.By joining our team, you'll be part of our life-changing Mission and Vision.You'll work in a truly inclusive environment where diversity and equ... Show more

 • Promoted

Compliance Auditor (SNF)

Evolve Therapy ServicesDetroit, MI, United States
Full-time

Evolve Therapy Services, LLC is a leading therapy management organization in the Long-term care industry.We may be a newer company by name, but our leadership has dozens of years of experience in t... Show more