Vendor Management Lead (Registered Nurse)

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

The Vendor Management Lead (RN) oversees vendor management operations from a market perspective, ensuring alignment with Humana’s clinical and operational standards. This role directs a team of RN professionals, fosters effective vendor and provider relationships, and drives resolution of clinical and operational issues to support quality care and compliance. The Vendor Management Lead (RN) is responsible for overseeing the vendor management functions from a market perspective, ensuring alignment between Humana’s business and clinical operations, vendor partners, and providers. This role provides strategic direction, leadership, and support to a team of Senior Vendor Management Professionals (RN), facilitating effective issue resolution, gap identification, and process optimization to advance quality care and operational excellence. This leader will build positive strategic partnerships with Contracting to align on Institutional Special Needs Plan providers and have oversight of SNF provider network and optimization from the clinical perspective. This role will also work with Provider Engagement to monitor outcomes for Value Based and Delegated Services Providers.

Provide strategic leadership and guidance to the Senior Vendor Management Professional (RN) team, ensuring effective execution of vendor management initiatives in accordance with Humana’s policies and regulatory requirements. Oversee and optimize vendor relationships, including performance monitoring, compliance management, and the resolution of complex operational and clinical issues. Facilitate collaboration between Humana, vendor partners, and providers, ensuring clear communication channels and the successful implementation of market-based strategies. Support the review of clinical authorizations and ensure consistency with established guidelines for various levels of care, leveraging clinical expertise and best practices. Identify systemic gaps and process improvement opportunities across vendor partnerships, developing and implementing action plans to close gaps and enhance service delivery. Analyze market trends, operational data, and vendor performance metrics to inform decision-making and drive continuous quality improvement. Ensure adherence to privacy, security, and enterprise information protection protocols, escalating issues as appropriate and maintaining compliance with internal procedures. Mentor and develop team members, fostering a culture of accountability, collaboration, and professional growth. Participate in strategic planning, vendor selection, and contract negotiations as needed, ensuring alignment with organizational objectives and clinical standards. Represent the vendor management function in cross-functional meetings, audits, and enterprise initiatives.