The Program Manager will lead complex, high-volume federal healthcare programs by overseeing operational performance, compliance, and cross-functional integration. They are responsible for driving priorities, managing client deliverables, and ensuring operational excellence through data-driven decision-making.
The IDR Compliance Specialist conducts compliance reviews of eligibility determinations and arbitration decisions to ensure alignment with federal regulations and CMS policies. They also assist in drafting internal policies, tracking compliance data, and supporting audit activities to maintain operational standards.
The Claims Review Physician will resolve claim disputes submitted by various healthcare providers and institutions. They will also provide assistance to health care plans and providers regarding the resolution of claims.
The Claims Review Nurse will conduct initial assessments of claim documentation and collaborate with clinical professionals to determine the medical necessity of services. They are responsible for drafting determination letters and facilitating the resolution of disputes between healthcare providers and payers.
