Program Director - Federal Health (CMS)

Commence • Virginia Beach, VA

6d • $150,000 - $200,000 • Remote

About The Position

At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care. The Program Director as the senior operational leader for a CMS contract under the Centers for Medicare & Medicaid Services (CMS). This individual is the primary day-to-day point of contact for CMS and is accountable for all aspects of contract performance, including delivery timelines, regulatory reporting, workforce management, and operational quality. The Program Director leads a large, 100+ multi-disciplinary team comprising clinical reviewers, medical coders, customer service staff, and IT personnel, ensuring all program activities meet or exceed contractual performance standards. This is a high-visibility, high-accountability role that demands deep expertise in Medicare Fee-for-Service (FFS) program operations, federal contracting environments, and large-scale healthcare program management.

Requirements

• 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.
• Demonstrated experience managing teams of 100 or more staff in a federal healthcare contractor environment.
• Bachelor’s degree required; Master’s degree preferred. In lieu of a Master’s degree, 4 additional years of relevant experience may be substituted.

Nice To Haves

• Prior 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.
• Working knowledge of CMS reporting cadences, contract kickoff processes, and the COR/CO relationship structure in a federal contracting environment.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager