CAREERS AT RAINMAKERS

Program Manager (PM)

Remote, Any where in the US — Immediate Hire

Rainmakers Strategic Solutions LLC is a fast growing, high performing business delivering value-added consulting services that enable our clients to envision, implement and measure achievement of their transformational and strategic goals. We are committed to Excellence, Passion, Diversity and Knowledge. Rainmakers offers comprehensive benefits and highly competitive compensation packages.

The Program Manager (PM) shall apply disciplined project management processes to effectively manage all tasks associated with the Recovery Audit Contractor Validation Contractor (RVC) in accordance with the client-approved project management plan and operations manual. The PM shall have authority to act for on behalf of Rainmakers on all contract matters relating to daily operations.

Essential Functions
Key Duties/Responsibilities/Accountabilities

  • Development and adherence to a comprehensive project management plan and project operations manual.
  • Serve as the primary client point of contact and responsible for day-to-day contact and timely response to client inquiries.
  • Oversee all project activities, including medical coding and medical necessity reviews in accordance with Medicare regulations and CMS policies.
  • Accountable for client satisfaction ratings.
    Accountable for timely and accurate completion of project tasks.
  • Oversee all daily operations, staff and contract performance.
  • Obtaining staff necessary to conduct the work.
  • Onboarding and training project staff.
  • Clear, concise, accurate and timely monthly and annual reports.
  • Responsible to project cost controls.


Non-Essential Duties and Functions

  • Other duties as assigned


Minimum Qualifications

  • Five (5) or more years prior work experience as a PM.
  • Experience in medical review and extensive nursing clinical experience in a variety of health care settings (e.g. acute care, sub-acute care, long term care, rehabilitative services, home health, skilled nursing, diagnostic services, and outpatient services/settings).
  • Bachelor’s degree in nursing from an accredited institution, plus a master’s degree in business or management from an accredited institution (In lieu of a master’s degree, the PM shall have a bachelor’s degree and at least an additional three (3) years of related work experience in Program Management).
  • Current license in nursing in the United States or U.S. Territory.
  • Working comfort with Microsoft Office Suite applications (Word, Excel, Outlook, PowerPoint etc.).
  • Extensive knowledge of the Medicare program particularly the coverage and payment rules.


Preferred Qualifications

Above requirements and the following:

  • Relevant experience with a RAC /Medicare Administrative Contractor (MAC), health plan.
  • Working knowledge of appeals processes and requirements, including re-openings, reconsiderations, and ALJ hearings with detailed experience and federal court or administrative hearing experience.
  • Working knowledge of Microsoft Access, SharePoint, and Project.


Environment and Cognitive/Physical Demands

  • Teleworking, virtual work environment.
  • Ability to read, hear, speak, keyboard, reason, communicate effectively and problem solve.
  • Requires prolonged sitting and telephone use.
  • Requires the use of office equipment such as computer terminals, telephones, copiers and printers.
  • Infrequent lifting to 15 pounds.
  • Infrequent stooping.
  • Periodic travel.


Segregation of Duties

Employees are accountable for performing their job responsibilities per Rainmakers’ core values, as well as policies and procedures, including but not limited to: segregation of duties, HIPAA, security and privacy, CMS requirements, the Rainmakers Compliance Program and any other applicable laws, rules and regulations.

Statement of Other Duties

This document describes the essential functions, requirements, and responsibilities of this job, and is not intended to be a complete list of all tasks and functions. Employees may be requested to perform job related tasks other than those specifically listed in this description and may be required to perform any task requested by the supervisor or management.

CMS Access Compliance and Regulation Contingency Statement

Some positions require compliance with (i) federal and agency specific regulations and related clauses included in Rainmakers’ prime contracts with the Government, (ii) background checks, and (iii) eligibility for a government-issued identification card.

Equal Employment Opportunity

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities as well as Sexual Orientation or Gender Identity.

 

 

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