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Government Programs Director
Government Programs DirectorInfinite Computer Solutions • Washington, DC, United States
Government Programs Director

Government Programs Director

Infinite Computer Solutions • Washington, DC, United States
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  • [job_card.full_time]
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Program Manager, Government Programs

Position Summary

The Program Manager, Government Programs is responsible for the day‑to‑day operational execution of Zyter’s CMS and government‑sponsored initiatives, including the WISe‑R model and future government programs. This role oversees daily program operations, provider escalations, reporting, quality monitoring, and coordination across clinical, operational, and technical teams. The Program Manager ensures that Zyter meets all CMS requirements, internal performance standards, and delegation oversight expectations. This role supports the Program Director in strategic planning and governance, but is directly accountable for operational accuracy, timeliness, documentation, and issue resolution.

Key Responsibilities

Daily Program Operations

  • Manage day‑to‑day execution of WISe‑R and other government program workflows.
  • Coordinate operational tasks including intake, case routing, documentation, timeline tracking, and cross‑team communication.
  • Ensure program activities follow established SOPs, CMS model guidance, and Zyter’s compliance requirements.

Provider Escalations and Issue Resolution

  • Serve as the primary point of contact for provider questions, escalations, status checks, and clarification requests.
  • Investigate issues, coordinate with clinical partners and operational teams, and provide timely and accurate responses.
  • Track trends in escalations and identify opportunities for process improvements.

    • Reporting, Data Integrity, and CMS Deliverables

  • Prepare required CMS and internal reports including utilization metrics, quality indicators, operational KPIs, and structured data fields.
  • Validate data accuracy in collaboration with analytics and data engineering.
  • Maintain reporting calendars, ensure timely submissions, and support the Program Director with high‑level summaries and insights.

    • Quality Monitoring and Compliance Activities

  • Conduct ongoing quality checks, documentation reviews, and compliance validation across all program workflows.
  • Support NCQA and URAC alignment by monitoring timeliness, completeness, and accuracy of UM, CM, and DM activities.
  • Support audit readiness through documentation management, evidence collection, and corrective action tracking.

    • Delegation Oversight Support

  • Monitor performance of delegated clinical partners including AllMed and any supplemental vendors.
  • Track SLAs, turnaround times, and quality metrics; raise issues to the Program Director when trends or risks appear.
  • Maintain oversight artifacts including monitoring logs, reports, and follow‑up actions.

    • Cross‑Functional Coordination

  • Serve as the operational point of coordination with clinical, analytics, product, engineering, support, and account management teams.
  • Ensure teams have updated requirements, timelines, priorities, and model interpretation guidance.
  • Facilitate internal meetings and working sessions to drive program tasks to completion.

    • Operational Documentation and Governance Support

  • Maintain SOPs, workflows, job aids, training materials, and updated CMS guidance repositories.
  • Document program decisions, action items, issues, risks, and recommendations.
  • Support the Program Director in governance meetings, executive summaries, and CMS‑facing materials.

    • Qualifications

  • Bachelor’s degree in health administration, public health, nursing, business, or a related field required.
  • Five or more years of experience in health plan operations, UM, CM, DM, government programs, or CMS‑regulated environments.
  • Strong knowledge of CMS program requirements, reporting standards, and regulatory timelines.
  • Experience with data validation, reporting, quality monitoring, and delegated oversight strongly preferred.
  • Ability to manage provider interactions and escalations with professionalism and accuracy.
  • Comfortable working in fast‑paced, cross‑functional environments with multiple stakeholders.
  • Excellent communication, organization, and documentation skills.
  • Experience with AI‑enabled workflows or healthcare technology platforms is a plus.

    • Experience

    5–10 years of experience.

    Seniority Level

    Mid‑Senior level

    Employment Type

    Full‑time

    Job Function

    Legal

    Industries

    IT Services and IT Consulting

    #J-18808-Ljbffr

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