Program Manager - Federal IDRE ServicesAbout the RoleWe are seeking an experienced and highly organized Program Manager to oversee day-to-day operations for our Federal Independent Dispute Resolution Entity (IDRE) program supporting the No Surprises Act. This role is responsible for managing program operations, ensuring quality and timeliness of deliverables, leading and mentoring team members, and driving operational efficiency.
The ideal candidate brings strong healthcare operations experience, leadership skills, knowledge of claims review processes, and the ability to manage multiple priorities in a fast-paced environment.
Key Responsibilities- Provide operational oversight and direction for Federal IDRE contract deliverables and team activities
- Manage daily operations, workflows, timelines, and project deliverables to ensure compliance with Federal IDRE requirements
- Monitor program performance metrics, budgets, risks, and quality outcomes
- Develop and maintain standard operating procedures, job aids, and workflow documentation
- Supervise, mentor, coach, and support direct reports, including Project Specialists and Administrative Aides
- Collaborate with Arbitration Coordinators, contracted arbitrators, and subject matter experts to ensure complete and accurate case reviews
- Research and interpret Federal No Surprises Act regulations and related guidance from the Departments of Health and Human Services, Labor, and Treasury
- Apply healthcare claims review and/or clinical expertise to improve review pathways and operational efficiencies
- Identify operational challenges and implement risk mitigation strategies
- Build and maintain strong customer and stakeholder relationships
- Ensure compliance with HIPAA, FISMA, URAC, CMS, and other applicable regulations
- Participate in conferences, meetings, and professional development activities as appropriate
QualificationsRequired- Bachelor's degree in Nursing or related healthcare field OR equivalent relevant experience
- Minimum 5 years of clinical or related healthcare experience
- Minimum 3 years of management or supervisory experience
- Healthcare claims review experience
- Strong understanding of healthcare operations, medical claims, and reimbursement processes
- Excellent written, verbal, organizational, and project management skills
- Ability to interpret federal and state regulations
- Ability to manage multiple deadlines and priorities in a fast-paced environment
- Experience with written and electronic documentation review
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
Preferred- Master's degree
- Active nursing license
- Knowledge of the Federal No Surprises Act
- Utilization Management/Utilization Review experience
- Experience reviewing medical claims, EOBs, and remittance advice
- Quality improvement experience and familiarity with Lean Six Sigma methodologies
- PMP, Lean Six Sigma Green Belt, or Quality Improvement certifications
- Health information technology experience
What We're Looking For- Strong leadership and team development skills
- Exceptional problem-solving and critical thinking abilities
- Customer-focused mindset with the ability to build collaborative relationships
- Self-motivated professional who thrives in a dynamic environment
- Ability to work independently with minimal supervision
Work Environment- Fast-paced, deadline-driven healthcare operations environment
- Occasional work outside normal business hours may be required based on business needs
Why Join Us?You'll have the opportunity to play a key role in supporting a nationally significant healthcare program while working alongside a collaborative and mission-driven team focused on operational excellence, compliance, and quality outcomes.
This is a fully remote position. 
