Healthcare PMP Program Manager | Appeals & Hearings - Remote

Overview

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. 

In Short

• Manage a full-time, multidisciplinary team supporting healthcare appeal and application operations.
• Lead operational support for appeal adjudication processes, ensuring accurate review, documentation, and disposition of cases in accordance with applicable regulations and guidelines.
• Coordinate logistics and documentation preparation for administrative hearings, and ensure timely case progression for both pre- and post-hearing phases.
• Ensure timely, accurate drafting and disposition of appeal documentation.
• Supervise operational workflows for processing initial applications, verifying data, and executing post-decision actions.
• Coordinate with technical and operational staff to maintain process integrity and compliance.
• Drive continuous improvement initiatives and ensure adherence to contract deliverables and timelines.

Requirements

• Active Project Management Professional (PMP®) certification.
• Minimum of five (5) years of experience leading complex, multi-functional project teams.
• Bachelor’s degree from an accredited institution.
• Strong organizational and communication skills with the ability to manage competing priorities in a fast-paced environment.
• Medicare program knowledge, with a strong preference for Part C and risk adjustment experience.
• Experience with healthcare appeals, adjudication and reclassification applications.
• Experience managing teams that use Salesforce-based systems or other case/document management platforms.
• Knowledge of hearings, medical review operations, and government healthcare compliance requirements.

Benefits

• Equal employment opportunity employer.
• Merit-based personnel processes.
• Accommodations available for disabilities.