Clinical Vendor Governance – Program Manager

Job Title: Program Manager – Clinical Vendor Governance / Red Flag Review Council
Employment Type: Contract / Contingent
Location: Remote within the U.S.
Work Hours: Primarily U.S. Central Time business hours
Location Preference: Hartford, CT preferred
Experience: 7+ years
Engagement: Contract

Position Overview

We are seeking an experienced Program Manager – Clinical Vendor Governance to establish and manage a structured governance process for clinical vendors and provider organizations requiring elevated review.

The Program Manager will run the operating engine of the Clinical Vendor Red Flag Review Council, managing the complete governance lifecycle including case intake, readiness validation, agenda development, executive preparation, meeting coordination, decision documentation, action tracking, and follow-through to closure.

This is an internally focused role requiring close collaboration with Clinical Vendor Solutions & Management, Network Operations, Contracting, Medical Affairs, Legal, SIU, Payment Integrity, Compliance, and senior leadership.

The successful candidate will be comfortable working with senior executives, consolidating complex information, preparing executive-ready materials, driving accountability, and keeping multiple workstreams moving to completion.

Key Responsibilities

Council Operations & Governance

• Own the monthly council calendar, meeting invitations, scheduling, and ad hoc sessions.

• Develop and publish meeting agendas in partnership with the Council Chair.

• Prioritize cases based on urgency, risk exposure, and decision readiness.

• Prepare and distribute executive-level pre-read materials.

• Support meeting facilitation by managing time, agenda flow, and unresolved issues.

• Capture decisions, rationale, conditions, dissent, owners, and next steps.

• Publish post-council meeting recaps and action items.

Case Intake & Readiness

• Manage intake for vendors and provider organizations escalated for governance review.

• Validate cases for required business, financial, utilization, contractual, legal, network, medical policy, SIU, and compliance information.

• Identify and close information gaps before cases are presented to senior leadership.

• Prepare standardized case packages containing:

  • Vendor/provider profile

  • Reason for escalation

  • Key findings

  • Risk assessment

  • Options considered

  • Recommended action

• Prepare Council Chair and presenters for anticipated questions and decision points.

• Maintain a prioritized pipeline of vendors under review, on watch lists, and pending reassessment.

Program & Project Management

• Maintain the master action log with owners, deadlines, dependencies, and status.

• Drive corrective actions and follow-up activities through completion.

• Track governance holds, contracting restrictions, renegotiation activities, termination workstreams, and legal actions.

• Confirm closure of decisions and downstream activities with accountable owners.

• Manage the council workplan using Asana or comparable work management tools.

• Provide recurring status reports covering pipeline, decisions, open actions, aging items, and risks.

• Identify process gaps and recommend improvements to governance workflows.

Executive & Stakeholder Coordination

• Serve as the primary coordination point for senior stakeholders across multiple business functions.

• Coordinate with Executive Directors, AVPs, VPs, and other senior leaders.

• Manage stakeholder engagement between council meetings.

• Conduct pre-alignment discussions and coordinate data/information requests.

• Prepare executive-ready presentations, decision memoranda, escalation briefs, and summaries.

• Coordinate with Legal on authorized formal communications.

• Escalate matters requiring executive decisions with a clear summary of the issue, available options, and recommendation.

Documentation & Knowledge Management

• Maintain comprehensive council decision records.

• Develop and maintain templates for case packages, pre-reads, meeting recaps, and decision documentation.

• Maintain the SharePoint site and council resource library.

• Document standard operating procedures and governance processes.

• Ensure records are organized, retrievable, and suitable for audit, compliance, and legal requirements.

Required Qualifications

• 7+ years of experience in Program Management, Project Management, Chief of Staff, or a similar role.

• Experience directly supporting executive-level governance forums, councils, or decision committees.

• Proven experience preparing, facilitating, and documenting meetings involving senior executives.

• Strong understanding of contracting concepts, including agreements, obligations, termination provisions, renegotiation, and contracting restrictions.

• Working knowledge of medical policy, clinical appropriateness, utilization controls, and policy alignment.

• Direct experience in clinical vendors, managed care, health plans, provider organizations, healthcare operations, or related environments.

• Understanding of utilization management, network operations, and vendor performance.

• Excellent written and verbal communication skills.

• Ability to transform complex, multidisciplinary information into concise executive-level recommendations.

• Strong follow-up and accountability skills with demonstrated ability to drive actions through closure.

• Ability to independently manage multiple concurrent cases and competing priorities.

• Advanced proficiency with PowerPoint, Excel, SharePoint, and Microsoft Teams.

Preferred Qualifications

• Experience with vendor governance, risk, compliance, credentialing, or similar committees.

• Familiarity with Medicare, Medicaid, and Commercial healthcare lines of business.

• Experience working with Legal, Compliance, SIU/Special Investigations, and Payment Integrity teams.

• Experience with Asana or similar project/work management platforms.

• Experience with QuickBase or comparable intake and tracking systems.

• PMP certification or equivalent program/project management experience.

Required Core Competencies

• Executive Presence: Ability to confidently coordinate with and support senior executives.

• Governance & Readiness: Ability to ensure cases are complete and decision-ready before executive review.

• Program Management: Strong ownership of timelines, dependencies, risks, and deliverables.

• Stakeholder Management: Ability to coordinate across multiple business functions and hold stakeholders accountable.

• Healthcare Domain Knowledge: Understanding of clinical vendors, healthcare operations, contracting, utilization, and network management.

• Communication: Ability to create concise, executive-ready presentations and written materials.

• Follow-Through: Strong ability to track and close action items without continuous supervision.

• Operational Excellence: Ability to establish repeatable processes and continuously improve governance workflows.

Key Tools / Platforms

• Microsoft Teams

• Outlook

• PowerPoint

• Excel

• SharePoint

• Asana

• QuickBase

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