Note: The job is a remote job and is open to candidates in USA. iMPROve Health is seeking a Program Manager to oversee day-to-day operations for its Federal Independent Dispute Resolution Entity (IDRE) program supporting the No Surprises Act. The role manages program operations, regulatory and contractual compliance, case workflows, and remote team leadership and development.
Responsibilities
- Rectly supervise, coach, mentor, and develop team members, including Project Specialists and Administrative Aides, to promote accountability, engagement, and consistent performance
- Establish and maintain clear communication practices for a remote team, including timely responses to Microsoft Teams messages, email, and other work-related communications
- Lead scheduled virtual team meetings, establish agendas, communicate priorities, document action items, and follow through to ensure commitments are met
- Conduct regular, scheduled one-on-one meetings with direct reports to review workloads, progress, performance, challenges, and professional development needs
- Establish clear expectations for responsibilities, deliverables, deadlines, and quality standards; monitor performance and address concerns promptly
- Maintain an active leadership presence and provide timely guidance and decision-making support to keep work moving forward
- Foster a collaborative, inclusive, and accountable remote work environment through proactive communication, relationship-building, and consistent leadership practices
- Identify training needs, support employee development, and provide constructive feedback and performance guidance
- Monitor team capacity and workload distribution, adjusting assignments and priorities as needed to meet program requirements
- Provide day-to-day operational oversight for Federal IDRE program activities, contract deliverables, case workflows, and team responsibilities
- Manage program schedules, deadlines, work assignments, and deliverables to ensure compliance with contractual, regulatory, and organizational requirements
- Monitor program performance metrics, productivity, quality outcomes, budgets, risks, and operational trends; identify opportunities for improvement
- Develop, maintain, and implement standard operating procedures, job aids, workflow documentation, and other operational resources
- Identify workflow inefficiencies, operational challenges, and potential compliance risks; develop and implement appropriate corrective and preventive actions
- Coordinate with Arbitration Coordinators, contracted arbitrators, subject matter experts, and other stakeholders to support complete, accurate, and timely case reviews
- Apply healthcare claims review and/or clinical expertise to evaluate review processes, resolve operational issues, and improve efficiency
- Research and interpret Federal No Surprises Act regulations and related guidance from the U.S. Departments of Health and Human Services, Labor, and the Treasury
- Support contract performance, customer expectations, and continuous quality improvement through effective planning, monitoring, and follow-through
- Ensure program activities adhere to applicable HIPAA, FISMA, URAC, CMS, contractual, and other relevant regulatory requirements
- Build and maintain productive relationships with internal teams, customers, external partners, and other program stakeholders
- Communicate operational updates, emerging issues, risks, and performance concerns to leadership in a timely and professional manner
- Participate in conferences, program meetings, and professional development activities as appropriate
Skills
- Demonstrated experience managing and engaging a remote or geographically dispersed team is required
- Bachelor's degree in Nursing or a related healthcare field, or equivalent relevant education and experience
- At least five years of clinical or related healthcare experience
- At least three years of management or supervisory experience, including direct responsibility for employee performance and development
- Demonstrated experience managing a remote or geographically dispersed team, including establishing communication routines, leading virtual meetings, conducting regular one-on-one meetings, and maintaining accountability for team performance
- Experience using Microsoft Teams or comparable collaboration platforms to communicate with employees, lead meetings, coordinate work, and support day-to-day team operations
- Professional experience reviewing healthcare claims
- Strong understanding of healthcare operations, medical claims, and reimbursement processes
- Excellent written and verbal communication, organizational, problem-solving, and project management skills
- Ability to interpret and apply federal and state regulations and program requirements
- Demonstrated ability to manage competing priorities, monitor deadlines, and ensure timely completion of deliverables in a fast-paced environment
- Experience reviewing written and electronic documentation for accuracy, completeness, and compliance
- Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint
- Ability to lead a distributed team, maintain employee engagement, and ensure work progresses effectively without in-person supervision
- Ability to plan and lead meetings, maintain regular one-on-one meetings, track action items, and follow through on commitments and deadlines
- Ability to establish clear expectations, monitor results, provide constructive feedback, and address performance or workflow concerns promptly
- Ability to share information clearly, listen effectively, and build productive working relationships across departments and with external stakeholders
- Ability to evaluate complex operational and regulatory issues, identify root causes, and develop practical solutions
- Ability to anticipate challenges, take ownership of responsibilities, and adjust priorities as program needs evolve
- Master's degree in a relevant field
- Active nursing license
- Knowledge of the Federal No Surprises Act and Independent Dispute Resolution processes
- Utilization Management or Utilization Review experience
- Experience reviewing medical claims, explanations of benefits (EOBs), and remittance advice
- Quality improvement experience and familiarity with Lean Six Sigma methodologies
- PMP, Lean Six Sigma Green Belt, or other quality improvement certifications
- Health information technology experience
- Experience managing operational performance metrics, service-level expectations, and process improvement initiatives
- Commitment to accuracy, timeliness, thorough documentation, and adherence to applicable requirements
Benefits
- 100% remote, with the flexibility to work from anywhere in the United States
- Professional development and continuing education opportunities
Company Overview