Note: The job is a remote job and is open to candidates in USA. Commence is a company focused on data-driven transformation in healthcare, aiming to improve health outcomes and efficiency. The Program Manager will lead operations for a CMS contract, ensuring compliance and performance while managing a diverse team.
Responsibilities
- Serve as the single, accountable point of contact for CMS, including the Contracting Officer Representative (COR) and Contracting Officer (CO), on all contract matters
- Own all contractual delivery timelines, ensuring on-time submission of all deliverables, reports, and performance data required by the SOW
- Lead and manage a multi-disciplinary team including clinical reviewers, medical coders, customer service representatives, and IT staff; oversee hiring, training, performance management, and workforce planning
- Monitor and ensure compliance with all contractual performance standards (including timeliness, accuracy, and provider communication requirements); proactively identify and resolve operational issues before they escalate
- Oversee the development and submission of all required CMS reports, data deliverables, and program status updates in adherence to CMS reporting cadences
- Lead contract kickoff activities, transition planning, and ongoing relationship management with CMS stakeholders including the COR and CO
- Oversee Medicare Part A/B/DMEPOS claim review operations, including workflow design, case management systems, and quality assurance processes
- Manage subcontractor relationships and performance in alignment with prime contract requirements
- Champion a culture of compliance, accuracy, and continuous improvement across all program functions
Skills
- Minimum 5 years of professional experience in healthcare program management, federal contracting, or a related field
- Minimum 3 years of experience managing complex systems and workflows as a manager or supervisor
- Minimum 3 years of experience in Medicare Fee-for-Service (FFS) program operations
- Bachelor's degree required; Master's degree preferred. In lieu of a Master's degree, 4 additional years of relevant experience may be substituted
- Prior Project Manager or Program Director experience on a CMS medical review contract
- Operational familiarity with Medicare Part A, Part B, and DMEPOS claim review processes and adjudication workflows
- Demonstrated experience managing teams of 100 or more staff in a federal healthcare contractor environment
- Working knowledge of CMS reporting cadences, contract kickoff processes, and the COR/CO relationship structure in a federal contracting environment
Benefits
- This is a remote position.
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Company Overview