Senior Director, Third Party Risk Management

Provides enterprise-wide leadership and strategic direction for third party risk management from a compliance perspective, including the audit, monitoring, and oversight of delegated healthcare functions. Establishes the governance model, risk framework, enterprise standards, and multi-year roadmap to identify, assess, monitor, elevate, and remediate third party compliance risk across Medicare, Medicaid, and Marketplace environments. Holds accountability for program effectiveness, risk-based audit and monitoring, regulatory and accreditation readiness, and executive and board reporting.

Leads directors, other people leaders, and teams of audit, monitoring, compliance, and delegated oversight professionals, partnering with Compliance, Legal, Procurement, Operations, Enterprise Risk, and business owners to strengthen third party accountability and consistent enterprise execution.

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. A Certified Internal Auditor (CIA) certification is required for this role.

• Establishes the enterprise strategy, governance model, risk framework, and decision rights for third party risk management from a compliance perspective, aligning regulatory expectations, accreditation requirements, contractual obligations, enterprise risk appetite, and business objectives.
• Defines and sponsors the multi-year operating roadmap, investment priorities, performance measures, scalable processes and technology, and organizational capabilities needed to mature the program and meet enterprise demand.
• Owns the design and effectiveness of the enterprise third party risk management framework, including risk segmentation, due diligence standards, control expectations, quality assurance, and program effectiveness evaluation.
• Leads the enterprise delegated entity audit and monitoring program and directs risk-based audit plans for delegated entities, vendors, pharmacy benefit managers, third-party administrators, credentialing organizations, and other third parties.
• Oversees audit planning, execution, reporting, and validation, ensuring audit methodologies meet regulatory expectations and industry standards.
• Oversees auditing and monitoring of delegated operational, regulatory, clinical, pharmacy, claims, credentialing, utilization management, customer service, and other healthcare functions, including Medicare and Medicaid delegation oversight.
• Directs enterprise oversight of the third party lifecycle, establishing consistent requirements for due diligence, risk assessment, compliance monitoring, performance oversight, issue management, corrective action, termination or transition risk, and regulatory readiness.
• Directs audit issue identification, root cause analysis, corrective action validation, and closure. Establishes thresholds for risk acceptance, issue classification, escalation, remediation, and reporting, and serves as the senior escalation point for material, systemic, or cross-business third party compliance risks.
• Chairs enterprise governance forums and directs cross-functional decisions that strengthen third party risk transparency, accountability, and mitigation across Compliance, Legal, Procurement, Operations, Enterprise Risk, and business stakeholders.
• Oversees regulatory, contractual, and operational reporting from third parties. Leads organizational responses to CMS audits, external quality reviews, other regulatory examinations, delegated oversight reviews, external audits, and compliance assessments related to third party performance, including responses to significant findings and systemic control deficiencies.
• Advises executive leaders and business owners on…