Title: Director, Vendor Performance Management Job Type: Full-time Location: Hybrid - 4 days per week in Brighton, MA office; 1 day remote FLSA Status: Exempt Position OverviewThe 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.
Key Responsibilities Vendor Governance & Delegation Oversight - 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.
SLA & Performance Management - 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.
Claims & Operational Vendor Oversight - Oversee claims vendor performance, including accuracy, timeliness, financial performance, and compliance.
- Partner with technical SMEs on claims configuration, testing, and issue resolution.
Compliance & Reporting - Ensure vendor oversight meets TRICARE/USFHP, DHA, HIPAA, and accreditation requirements.
- Report vendor performance, risk, and remediation status to leadership and governance committees.
Leadership & Team Management - 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.
Requirements
QualificationsEducation & Experience - Bachelor's degree required; Master's degree preferred.
- 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; government-program experience preferred.
Skills & Competencies - 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.
- Experience with Medicare, TRICARE, managed care, or government-sponsored health programs preferred.
Other Requirements - Must be able to obtain and maintain U.S. Government personnel security clearance as a condition of employment.
Physical Nature of the Job Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move throughout the campus.
Salary Description
$135,000.00-155,000.00 per year
