Bachelor's degree in Nursing or related healthcare field, or equivalent experience.
Minimum five years of clinical or healthcare experience.
At least three years of management or supervisory experience.
Experience managing a remote team with established communication routines.
Proficient in Microsoft Teams or similar collaboration tools.
Professional experience in healthcare claims review.
Strong understanding of healthcare operations and reimbursement processes.
Responsibilities
Supervise, coach, and develop remote team members to enhance performance.
Establish clear communication practices and lead virtual team meetings.
Conduct regular one-on-one meetings to discuss workloads and professional development.
Monitor team performance and address concerns promptly.
Provide operational oversight for Federal IDRE program activities and compliance.
Identify workflow inefficiencies and implement corrective actions.
Coordinate with stakeholders to ensure timely case reviews.
Benefits
Fully remote work environment.
Opportunity to influence program performance and operational processes.
Support for employee development and training needs.
Engagement in a mission-driven organization focused on healthcare quality.
Participation in professional development activities.
Full Job Description
Program Manager - Federal IDRE Services iMPROve Health | Fully Remote About iMPROve Health iMPROve Health is a mission-driven healthcare services organization committed to improving healthcare quality, efficiency, and outcomes. We partner with healthcare organizations and stakeholders to support effective, compliant, and high-quality healthcare programs. We are seeking an experienced, proactive, and highly organized Program Manager - Federal IDRE Services to oversee day-to-day operations for our Federal Independent Dispute Resolution Entity (IDRE) program supporting the No Surprises Act. This position plays a key role in managing program operations, ensuring regulatory and contractual compliance, coordinating case workflows, and supporting the successful delivery of program requirements. This role combines healthcare operations, regulatory compliance, project management, and hands-on team leadership. The successful candidate will provide operational oversight while directly supervising, coaching, and developing team members to promote accountability, engagement, productivity, and quality. Demonstrated experience managing and engaging a remote or geographically dispersed team is required. The Program Manager must establish consistent communication practices, lead effective virtual meetings, conduct regular one-on-one meetings with direct reports, monitor workloads and performance, address concerns promptly, and ensure team members have the direction and resources needed to succeed. The ideal candidate is an engaged, responsive, and accountable leader who can balance operational priorities with employee development, build a collaborative remote team culture, and maintain high standards for quality, productivity, and regulatory compliance. Key Responsibilities Remote Team Leadership and Performance Management 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.
Program and Operational Management
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.
Compliance and Stakeholder Relations
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.
Qualifications Required Qualifications
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.
Preferred Qualifications
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.
Leadership Competencies The successful candidate will demonstrate:
Remote leadership and accountability: Ability to lead a distributed team, maintain employee engagement, and ensure work progresses effectively without in-person supervision.
Responsiveness and accessibility: Proactive communication, timely responses to work-related inquiries, and availability to provide direction and resolve issues during established working hours.
Organization and follow-through: Ability to plan and lead meetings, maintain regular one-on-one meetings, track action items, and follow through on commitments and deadlines.
Performance management: Ability to establish clear expectations, monitor results, provide constructive feedback, and address performance or workflow concerns promptly.
Communication and collaboration: Ability to share information clearly, listen effectively, and build productive working relationships across departments and with external stakeholders.
Critical thinking and problem-solving: Ability to evaluate complex operational and regulatory issues, identify root causes, and develop practical solutions.
Initiative and adaptability: Ability to anticipate challenges, take ownership of responsibilities, and adjust priorities as program needs evolve.
Quality and compliance focus: Commitment to accuracy, timeliness, thorough documentation, and adherence to applicable requirements.
Work Environment
Fully remote position requiring effective independent work and active collaboration with a geographically dispersed team.
Regular participation in scheduled virtual meetings, one-on-one meetings with direct reports, and timely communication through Microsoft Teams, email, and other established work channels.
Fast-paced, deadline-driven healthcare operations environment with competing priorities and time-sensitive deliverables.
Occasional work outside normal business hours may be required based on business needs.
Why Join iMPROve Health? Join iMPROve Health and contribute to a mission-driven organization supporting healthcare quality and the integrity of the Federal IDR process. As Program Manager, you will have the opportunity to influence program performance, develop a high-performing remote team, strengthen operational processes, and support the quality, accuracy, and efficiency of Federal IDRE services.
