Senior Director, Third Party Risk Management

Position Purpose:

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, escalate, 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.

Key Details:  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.

Key Responsibilities:

• 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 regulatory change, emerging risk, third party concentration or dependency concerns, and significant control gaps, influencing enterprise priorities and corrective actions.
• Directs executive and board-level reporting on risk exposure, trends, material issues, program performance, and remediation status, translating complex information into recommendations that support enterprise decisions and risk prioritization.
• Leads directors, other people leaders, and teams of auditors, monitoring specialists, compliance analysts, and delegated oversight professionals. Establishes organizational structure, resource planning, succession and talent strategies, leadership expectations, and accountability for consistent enterprise outcomes.
• Performs other duties as assigned.
• Complies with all policies and standards

Education/Experience

• Bachelor's Degree Business Management, Health Administration, or related field; or, equivalent work experience. Required

• Master's Degree preferred

• 10+ years Progressively responsible experience in audit, compliance, enterprise risk, and/or third party risk management, including responsibility for complex, enterprise-scale programs.

• Leadership experience leading managers or other people leaders and directing work across multiple business areas or operating units.

• Experience advising executive leadership and presenting material risk, program performance, or regulatory matters to executive governance committees and/or boards.

• Knowledge of healthcare regulatory requirements and government-sponsored programs, including Medicare, Medicaid, and Marketplace environments.

Licenses/Certifications:

• Certified Internal Auditor (CIA) required
• Certified in Healthcare Compliance (CHC) preferred:

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act