HEALTHCARE PROGRAM MANAGER

HEALTHCARE PROGRAM MANAGER

Healthcare Management Solutions is seeking a program manager for an upcoming project focused on program integrity medical record reviews for federal payor programs. The project manager's roles and responsibilities within this program include day to day contact with the CPI/CMS Contracting Officer's Representative (COR), Standard Business Function Lead (BFL) and Program Integrity BFL, and the general oversight of the contract performance including obtaining and maintaining the staff necessary to conduct this work.

Education/Experience:

• A master's degree from an accredited institution or substitution with a bachelor's degree from an accredited institution with four (4) additional years of related work experience in lieu of the master's degree.
• A minimum of five (5) years of professional experience with at least three (3) years as a manager responsible for managing complex systems and workflow.
• Prior work experience in the Medicare and Medicaid programs, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines.
• Medical review experience is also required in the area of Program Integrity investigation of fraud, waste, and abuse.

Program Description

The Center for Program Integrity (CPI) and other areas of the Centers for Medicare & Medicaid Services (CMS) collaborate with contractors to monitor the accuracy of Medicare and Medicaid medical review decision making, the ability to implement Medicare coverage, coding, payment, and billing policies and the identification of potential fraud, waste, or abuse. The goal of the program is to reduce payment error by preventing the initial payment of claims that do not comply with Medicare's coverage, coding, payment, and billing policies.

EOE STATEMENT: Healthcare Management Solutions, LLC has established an Affirmative Action Plan. HMS is deeply committed to the concept and practices associated with equal opportunity and affirmative action in all aspects of employment. HMS makes clear that all applicants will be treated without regard to race, color, sex, religion, national origin, age, disability, genetic information, sexual orientation, ancestry, marital status, changes in marital status, pregnancy or parenthood, gender, or gender identity or expression, military or veteran status, political affiliation, or any other protected characteristics under applicable law when the reasonable demands of the position(s) do not require distinction on the basis of age, disability, sex, marital status, changes in marital status, pregnancy, or parenthood.

This company does not tolerate unlawful discrimination in its employment practices. We recognize the value of diversity in our workforce and encourage all qualified candidates to apply. We thank all candidates who choose to apply, however, only those selected for a further interview will be contacted.

Equal Opportunity Employer/M/F/Vet/Disabled. HMS is an EEO/AA/E-Verify compliant and drug free workplace employer.