Director, Vendor Performance Management
BrightonOne•Boston, MA
•$135,000 - $155,000•Hybrid
About The Position
The Director, Vendor Performance Management leads USFHP's oversight of third-party vendors and delegated functions, with particular focus on claims and other core operational vendors. The Director owns the vendor governance framework end to end — delegation oversight, SLA and performance management, audits, and remediation — ensuring vendors meet contractual, regulatory (TRICARE/USFHP, DHA), and quality obligations. The Director partners across operations, compliance, finance, and clinical teams and reports vendor performance and risk to leadership and governance committees.
Requirements
- Bachelor's degree required
- 10 or more years of vendor management, delegation oversight, claims operations, or health plan operations experience, including leadership.
- Experience with claims and delegated-vendor oversight in managed care
- Deep expertise in vendor/delegation oversight, SLA and contract management, and claims operations.
- Strong analytical, negotiation, and performance-management capabilities.
- Leadership, cross-functional collaboration, and vendor-relationship management skills.
- Excellent communication and collaboration with technical subject-matter experts and vendors.
- Proficiency in Microsoft Office Suite and platforms such as Facets, QNXT, HealthRules, or similar systems.
- Familiarity with CMS, URAC, NCQA, TRICARE, and healthcare regulatory requirements.
- Familiarity with CAQH, NPPES, PECOS, and provider credentialing databases.
- Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.
- Candidates must be authorized to work in the United States without sponsorship now or in the future.
Nice To Haves
- Master's degree preferred.
- Government-program experience preferred.
- Experience with Medicare, TRICARE, managed care, or government-sponsored health programs preferred.
Responsibilities
- Own the vendor management framework, including due diligence, onboarding, delegation agreements, and pre-delegation and annual delegation audits.
- Maintain delegation oversight consistent with contractual and accreditation (NCQA/URAC) requirements, including reporting and evidence.
- Manage the vendor inventory, risk tiering, and oversight calendar.
- Establish and manage SLAs, performance standards, and scorecards across claims and operational vendors.
- Conduct regular business reviews; monitor performance, identify gaps, and drive data-based accountability.
- Lead root-cause analysis, corrective action plans (CAPs), and remediation for underperformance, with escalation and, where needed, penalty/exit provisions.
- Oversee claims vendor performance, including accuracy, timeliness, financial performance, and compliance.
- Partner with technical SMEs on claims configuration, testing, and issue resolution.
- Ensure vendor oversight meets TRICARE/USFHP, DHA, HIPAA, and accreditation requirements.
- Report vendor performance, risk, and remediation status to leadership and governance committees.
- Lead, coach, and develop the vendor performance management team; partner with Human Resources on hiring and development.
- Partner with operations, compliance, finance, and clinical teams on vendor strategy and contracting.
Benefits
- Accommodations are available upon request for candidates taking part in all aspects of the selection process.
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What This Job Offers
Job Type
Full-time
Career Level
Director
