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iMPROve HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in healthcare operations and management, with a strong focus on overseeing program activities, ensuring compliance with federal regulations, and leading remote teams. Proficient in developing standard operating procedures and managing performance metrics to drive continuous quality improvement.
Highest-signal resume keywords
Healthcare Operations ManagementRemote Team LeadershipFederal No Surprises Act ComplianceHealthcare Claims ReviewQuality Improvement Methodologies
Tech Stack
Tools & technologiesAbout the role
Key responsibilities & impact- Oversee day-to-day operations for the Federal Independent Dispute Resolution Entity (IDRE) program supporting the No Surprises Act
- Provide operational oversight for program activities, contract deliverables, case workflows, and team responsibilities
- Directly supervise, coach, mentor, and develop Project Specialists and Administrative Aides
- Establish communication practices for a remote team and lead scheduled virtual team meetings
- Conduct regular one-on-one meetings with direct reports
- Establish expectations for responsibilities, deliverables, deadlines, and quality standards; monitor performance and address concerns
- Monitor team capacity and workload distribution, adjusting assignments and priorities
- Manage program schedules, deadlines, work assignments, and deliverables
- Monitor performance metrics, productivity, quality outcomes, budgets, risks, and operational trends
- Develop, maintain, and implement standard operating procedures, job aids, workflow documentation, and operational resources
- Identify workflow inefficiencies, operational challenges, and compliance risks; implement corrective and preventive actions
- Coordinate with Arbitration Coordinators, contracted arbitrators, subject matter experts, and stakeholders on case reviews
- Apply healthcare claims review and/or clinical expertise to evaluate review processes and resolve operational issues
- Research and interpret Federal No Surprises Act regulations and guidance from the U.S. Departments of Health and Human Services, Labor, and the Treasury
- Support contract performance, customer expectations, and continuous quality improvement
- Ensure adherence to HIPAA, FISMA, URAC, CMS, contractual, and other regulatory requirements
- Build relationships with internal teams, customers, external partners, and stakeholders
- Communicate operational updates, emerging issues, risks, and performance concerns to leadership
- Participate in conferences, program meetings, and professional development activities
Requirements
What you’ll need- 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
- Ability to manage competing priorities, monitor deadlines, 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
- Occasional work outside normal business hours may be required
- 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
Comp & perks- 100% remote work from anywhere in the United States
- Work/life balance
- Professional development opportunities
- Continuing education opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Healthcare Claims ReviewProgram ManagementPerformance Metrics MonitoringStandard Operating Procedures DevelopmentWorkflow DocumentationOperational Risk ManagementProject ManagementUtilization ManagementMedical Claims ReviewRegulatory Compliance
Soft Skills
Communication SkillsOrganizational SkillsProblem-Solving SkillsCoaching and MentoringTeam Collaboration
Tools & Technologies
Microsoft TeamsMicrosoft OfficeLean Six Sigma MethodologiesHealth Information Technology
Certifications & Qualifications
PMPLean Six Sigma Green BeltActive Nursing License
Industry Keywords
No Surprises ActIndependent Dispute ResolutionHealthcare RegulationsClinical ExpertiseContract Management