Program Director - Federal Health; CMS

Description

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.

At Commense, 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, Commense cuts straight to better care.

The Program Director as the senior operational leader for a CMS contract under the Centers for Medicare & Medicaid Services (CMS). This individual is the primary day-to-day point of contact for CMS and is accountable for all aspects of contract performance, including delivery timelines, regulatory reporting, workforce management, and operational quality. The Program Director leads a large, 100+ multi-disciplinary team comprising clinical reviewers, medical coders, customer service staff, and IT personnel, ensuring all program activities meet or exceed contractual performance standards.

This is a high-visibility, high-accountability role that demands deep expertise in Medicare Fee-for-Service (FFS) program operations, federal contracting environments, and large-scale healthcare program management.

• Serve as the single, accountable point of contact for CMS, including the Contracting Officer Representative (COR) and Contracting Officer (CO), on all contract matters.
• Own all contractual delivery timelines, ensuring on-time submission of all deliverables, reports, and performance data required by the SOW.
• Lead and manage a multi-disciplinary team including clinical reviewers, medical coders, customer service representatives, and IT staff; oversee hiring, training, performance management, and workforce planning.
• Monitor and ensure compliance with all contractual performance standards (including timeliness, accuracy, and provider communication requirements); proactively identify and resolve operational issues before they escalated.
• Oversee the development and submission of all required CMS reports, data deliverables, and program status updates in adherence to CMS reporting cadences.
• Lead contract kickoff activities, transition planning, and ongoing relationship management with CMS stakeholders including the COR and CO.
• Oversee Medicare Part A/B/DMEPOS claim review operations, including workflow design, case management systems, and quality assurance processes.
• Manage subcontractor relationships and performance in alignment with prime contract requirements.
• Champion a culture of compliance, accuracy, and continuous improvement across all program functions.

• Minimum 5 years of professional experience in healthcare program management, federal contracting, or a related field.
• Minimum 3 years of experience managing complex systems and workflows as a manager or supervisor.
• Minimum 3 years of experience in Medicare Fee-for-Service (FFS) program operations.
• Demonstrated experience managing teams of 100 or more staff in a federal healthcare contractor environment.
• Bachelor's degree required;
  Master's degree preferred. In lieu of a Master's degree, 4 additional years of relevant experience may be substituted.

• Prior Program Director experience on a CMS medical review contract.
• Operational familiarity with Medicare Part A, Part B, and DMEPOS claim review processes and adjudication workflows.
• Working knowledge of CMS reporting cadences, contract kickoff processes, and the COR/CO relationship structure in a federal contracting environment.

The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable…