[Hiring] Program Manager @MICHIGAN PEER REVIEW ORGANIZATION

Role Description

We are seeking an experienced, proactive, and highly organized Program Manager – Federal IDRE Services to oversee day-to-day operations for our Federal Independent Dispute Resolution Entity (IDRE) program supporting the No Surprises Act. This position plays a key role in managing program operations, ensuring regulatory and contractual compliance, coordinating case workflows, and supporting the successful delivery of program requirements.

This role combines healthcare operations, regulatory compliance, project management, and hands-on team leadership. The successful candidate will provide operational oversight while directly supervising, coaching, and developing team members to promote accountability, engagement, productivity, and quality.

Demonstrated experience managing and engaging a remote or geographically dispersed team is required. The Program Manager must establish consistent communication practices, lead effective virtual meetings, conduct regular one-on-one meetings with direct reports, monitor workloads and performance, address concerns promptly, and ensure team members have the direction and resources needed to succeed.

The ideal candidate is an engaged, responsive, and accountable leader who can balance operational priorities with employee development, build a collaborative remote team culture, and maintain high standards for quality, productivity, and regulatory compliance.

Qualifications

• Bachelor's degree in Nursing or a related healthcare field, or equivalent relevant education and experience.
• At least five years of clinical or related healthcare experience.
• At least three years of management or supervisory experience, including direct responsibility for employee performance and development.
• Demonstrated experience managing a remote or geographically dispersed team.
• Experience using Microsoft Teams or comparable collaboration platforms.
• Professional experience reviewing healthcare claims.
• Strong understanding of healthcare operations, medical claims, and reimbursement processes.
• Excellent written and verbal communication, organizational, problem-solving, and project management skills.
• Ability to interpret and apply federal and state regulations and program requirements.
• Demonstrated ability to manage competing priorities and ensure timely completion of deliverables.
• Experience reviewing written and electronic documentation for accuracy, completeness, and compliance.
• Proficiency in Microsoft Office applications, including Word, Excel, and PowerPoint.

Requirements

• Master's degree in a relevant field (preferred).
• Active nursing license (preferred).
• Knowledge of the Federal No Surprises Act and Independent Dispute Resolution processes (preferred).
• Utilization Management or Utilization Review experience (preferred).
• Experience reviewing medical claims, explanations of benefits (EOBs), and remittance advice (preferred).
• Quality improvement experience and familiarity with Lean Six Sigma methodologies (preferred).
• PMP, Lean Six Sigma Green Belt, or other quality improvement certifications (preferred).
• Health information technology experience (preferred).
• Experience managing operational performance metrics, service-level expectations, and process improvement initiatives (preferred).

Benefits

• 100% remote position offering flexibility to work from anywhere in the United States.
• Prioritization of work/life balance.
• Investment in employees’ growth through professional development and continuing education opportunities.

Work Environment

• Fully remote position requiring effective independent work and active collaboration with a geographically dispersed team.
• Regular participation in scheduled virtual meetings, one-on-one meetings with direct reports, and timely communication through Microsoft Teams, email, and other established work channels.
• Fast-paced, deadline-driven healthcare operations environment with competing priorities and time-sensitive deliverables.
• Occasional work outside normal business hours may be required based on business needs.