Position Overview The Program Director (PD) serves as the key leadership figure responsible for the total oversight and operational success of a high-volume medical record review program. The PD ensures that all contract requirements are met, including quality, cost control, timeliness, and the maintenance of strong professional relationships with government clients and stakeholders.
Key Responsibilities
- Operational Oversight: Provide end-to-end management of program operations, including document intake, data abstraction, appeals support, and quality assurance processes.
- Stakeholder Management: Establish and maintain effective lines of communication with internal teams, agency officials, and external stakeholders.
- Staffing & Resource Management: Ensure appropriate staffing levels are maintained to meet shifting audit volumes and contractual requirements. Oversee productivity metrics and ensure an adequate quality assurance program is strictly adhered to.
- Financial & Status Reporting: Submit accurate status and cost reports, including performance metrics. Proactively identify risks and develop plans to correct any variances.
- Risk Mitigation: Develop, execute, and maintain processes to mitigate risks and ensure project goals are met according to schedule.
- Compliance & Quality: Ensure all deliverables and operations conform to relevant security policies, privacy regulations, and accessibility requirements.
Required Qualifications
- Experience:
- Eight (8) or more years of professional experience in health care insurance or a related field.
- Demonstrated experience managing operations involving large volumes of sensitive data and medical records.
- Documented knowledge of the relevant health insurance program environment.
- Management experience: At least five (5) years of management experience (if holding a master's degree) or seven (7) years of management experience (if holding an accredited bachelor's degree).
- Education: A master’s or bachelor’s degree in public policy, health, or business from an accredited institution.
- Security Clearance: Must be able to pass a background investigation for access to sensitive information systems and facilities.
Performance Expectations
- Professionalism: Maintain high-level professional business relations with all project stakeholders.
- Strategic Planning: Successfully navigate operational "surge" periods, including the effective ramp-up and ramp-down of personnel capacity at the direction of the client representative.
Company Description
Our mission is to empower our clients to achieve sustainable success through efficient, cost-effective, and scalable solutions that drive significant performance improvements. We believe in delivering value-driven results and fostering a culture that attracts and retains top talent to provide scalable, adaptable services.