Healthcare PMP Program Manager | Appeals & Hearings

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.

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, Commence cuts straight to better care. 

We are seeking a skilled Project Manager to lead a healthcare operations support initiative focused on managing and processing appeals and applications related to Medicare programs. The ideal candidate will bring expertise in project leadership, case management systems, and healthcare operations—particularly in the areas of medical appeals, risk adjustment, and reclassification applications.

• Manage a full-time, multidisciplinary team supporting healthcare appeal and application operations.
• Lead operational support for appeal adjudication processes, ensuring accurate review, documentation, and disposition of cases in accordance with applicable regulations and guidelines.
• Coordinate logistics and documentation preparation for administrative hearings, and ensure timely case progression for both pre- and post-hearing phases.
• Ensure timely, accurate drafting and disposition of appeal documentation.
• Supervise operational workflows for processing initial applications, verifying data, and executing post-decision actions.
• Coordinate with technical and operational staff to maintain process integrity and compliance.
• Drive continuous improvement initiatives and ensure adherence to contract deliverables and timelines.

Qualifications

• Active Project Management Professional (PMP®) certification.
• Minimum of five (5) years of experience leading complex, multi-functional project teams.
• Bachelor’s degree from an accredited institution.
• Strong organizational and communication skills with the ability to manage competing priorities in a fast-paced environment.
• Medicare program knowledge, with a strong preference for Part C and risk adjustment experience.
• Experience with healthcare appeals, adjudication and reclassification applications.
• Experience managing teams that use Salesforce-based systems or other case/document management platforms.
• Knowledge of hearings, medical review operations, and government healthcare compliance requirements.

Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law. 

If you need assistance or an accommodation due to a disability, you may contact us at 757-306-4920 or hr@commence.ai