Manager of Vendor Compliance

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

Reporting to the Senior Director of Corporate Compliance and Privacy, the Manager, Vendor Compliance will oversee and manage the MetroPlusHealth (MPH) Vendor Compliance Program, ensuring adherence to compliance, privacy, and regulatory requirements for vendor compliance. The Manager, Vendor Compliance will lead risk assessments, operational audits, monitoring, and corrective action plans to ensure that First Tier, Downstream and Related Entities (FDRs) and second-tier vendors that perform administrative and health care service functions on behalf of the Plan comply with all contractual and regulatory obligations. The Manager, Vendor Compliance will supervise the Sr. Vendor Compliance Analyst, coordinate with internal stakeholders, and provide strategic oversight of vendor oversight to minimize risks for MetroPlusHealth.

• Lead the implementation, and oversight of the Vendor Compliance Program to ensure compliance with regulatory and contractual obligations.
• Track vendor issues and any changes in functions throughout the year to conduct a comprehensive annual vendor risk assessment which is used to develop the operational audit schedule for the following calendar year.
• Develop and manage compliance monitoring and auditing tools to track vendor compliance and performance.
• Oversee annual and ongoing audits of delegated vendors, ensuring internal stakeholders are held accountable for their responsibilities and deliverables.
• Guide and support internal stakeholders in creating effective auditing and monitoring tools.
• Collaborate with the Vendor Management & Oversight team to escalate and resolve identified compliance issues, including corrective action plans and follow-up audit items to ensure resolution.
• Partner with Legal, Procurement and internal stakeholders to properly evaluate vendors for potential classification as a first-tier or second-tier vendor.
• Participating in pre-delegation audits to ensure that a prospective vendor has policies and procedures in place that demonstrate they have effective compliance and privacy programs.
• Manage and train the Sr. Vendor Compliance Analyst, providing guidance and oversight. This includes assigning projects, managing workload, and ensuring the timely completion of vendor audits, and other reporting deliverables for the Vendor Delegation Oversight Subcommittee (VDOS), Internal Compliance Committee, and Audit and Compliance Committee of the Board of Directors.
• Actively participate in all monthly and/or quarterly vendor meetings, ensuring 1) vendor is addressing open requests, including CAPs, operational audit status and findings, and pending implementation deliverables and 2) vendor compliance issues are identified and appropriately managed.
• Work with State Regulatory Compliance, Federal & Integrated Regulatory Compliance, Product and Regulatory Affairs to carry-out implementations impacting our vendors. This include disseminating guidance, gathering necessary documentation and tracking progress in the internal Compliance database

• Bachelor's Degree in a health-related field, Master’s Degree preferred.
• 5-7 years of profession experience in a compliance, auditing, or vendor management within a Managed Care Organization.
• Experience with CMS, NYDOH and HIPAA vendor oversight requirements.
• Experience organizing, coordinating, and participating in FDR monitoring and auditing.
• Proven ability to articulate regulatory requirements to business and technical staff to capture information and achieve results.
• Minimum 3 years supervisory or managerial experience.
• Strong knowledge of vendor risk management, audit and compliance reporting.
• CHC Preferred

Professional Competencies

• Strong proficiency in Microsoft Excel, Word, PowerPoint, and SharePoint.
• Broad-based in-depth knowledge of the managed care industry, including strategic compliance planning, regulatory concerns, compliance requirements, and corporate integrity principles.
• The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
• High-level of skill in leading interdepartmental and cross-functional projects; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met.
• Strong team management skills
• Experience with managed care, Medicaid and federal regulations, quality improvement and compliance oversight.
• The utmost integrity in the discreet and confidential handling of confidential materials is necessary.

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