Government Program Operations Manager (Healthcare)

TL;DR

Government Program Operations Manager (Healthcare): Overseeing the implementation, compliance, and optimization of Medicare, Medicaid, and Exchange programs with an accent on technical analysis and operational efficiencies. Focus on designing automated solutions, validating deliverables, and ensuring system capabilities align with CMS and state regulatory guidance.

Location: Remote (US) or Hybrid (Denver or New York City)

Salary: $115,600 - $182,500 USD

Company

Enterprise health technology company providing a comprehensive suite of solutions for employers and health plans to rebuild trust in US healthcare.

What you will do

• Interpret and operationalize CMS and state regulatory guidance in collaboration with compliance teams.
• Oversee the timely implementation of regulatory changes and coordinate cross-functional workplans.
• Lead the development of automated tools and scalable solutions to improve operational efficiency and data accuracy.
• Analyze complex encounter and PDE data to identify trends, outliers, and improvement opportunities.
• Monitor internal operations, perform root cause analysis for errors, and implement corrective actions.
• Define business and reporting requirements to support system enhancements and process improvements.

Requirements

• 5+ years of healthcare data experience.
• 5+ years of PBM and/or Health Plan experience supporting Medicare Part D, Medicaid, or Exchange plans.
• 5+ years of experience working with SQL, R, or Python.
• Experience working with cross-functional teams to balance multiple complex projects.
• Excellent written and verbal communication skills.
• Must be based in the US.

Culture & Benefits

• Flexible work arrangements with options for full remote (US) or hybrid (Denver/NYC).
• Collaborative environment focused on high performance and professional growth.
• Opportunity to work with a leading proprietary Enterprise Health Platform (EHP).
• Commitment to diversity, equity, and inclusion in the workplace.