PROGRAM MANAGER (IDRE) - Remote

MICHIGAN PEER REVIEW ORGANIZATION• REMOTE, US,

1d•$90,000 - $100,000•Remote

About The Position

We 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.

Requirements

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)

Nice To Haves

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

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