Remote Project Manager/Director (PD)- (CMS, IDRE Audit)

We are building a team to deliver the Independent Dispute Resolution (IDR) Entity Audit for the Centers for Medicare & Medicaid Services (CMS), in support of the Departments of Health and Human Services, Labor, and the Treasury (the Tri-Departments). 

Enacted as part of the Consolidated Appropriations Act of 2021, the No Surprises Act (NSA) protects patients from unexpected out-of-network medical bills. When an insurer and an out-of-network provider cannot agree on a payment amount, the Federal IDR Process allows a certified IDR entity to determine the appropriate payment. Our team will independently audit those certified IDR entities to verify that their eligibility and payment determinations are compliant with the NSA and its implementing regulations — directly supporting decisions about certification, recertification, and revocation.

The Project Manager/Director serves as the official interface with CMS for the duration of the engagement. The PM is responsible for coordinating the management of all work performed under the contract, leading the organization and obtaining the staff and resources necessary to execute the task order, and is held accountable for the outcomes of the task order and for resolving any obstacles to its success.

This is a fully remote position. The place of performance is remote, not at a CMS facility, so the selected candidate may work from any location within the Continental United States. Occasional travel to CMS offices in Baltimore, MD may be required for kickoff, milestone reviews, or stakeholder meetings.

This is a senior leadership role for an experienced federal program leader who can stand up an audit operation from kickoff through Phase 1 baseline establishment, lead the transition to Phase 2 scaled operations, and sustain high-quality performance across the full five-year period of performance.

• Serve as the primary liaison to the Government on all contract issues and policy matters, coordinating with the CMS Contracting Officer (CO) and Contracting Officer’s Representative (COR).
• Lead the post-award Kick-Off Meeting and orientation briefing within seven (7) business days of award, addressing management approach, project work plan, staffing, communications, risk management, and configuration management.
• Develop, maintain, and execute the Project Management Plan and Integrated Master Schedule (IMS), revising the work plan no more frequently than monthly as project conditions evolve.
• Manage project staff and any subcontractors to meet timelines established for both standard and expedited review of Eligibility Determinations and Payment Determinations.
• Ensure timely delivery of high-quality deliverables, including the Audit Strategy, Audit Roadmap, individual audit reports, the Preliminary and Final Annual Audit Reports, and the Operational Readiness and Transition Report.
• Advise CMS in a timely manner of any difficulties arising from contract administration, including sudden increases in inquiry or appeal volume and the team’s ability to absorb workload challenges; manage project costs.
• Provide quality assurance on all draft audit reports to ensure sufficient rationale is documented for every audit decision.
• Lead recruiting, retention, onboarding, and replacement of qualified personnel; scale resources in response to evolving audit volumes and program needs.
• Oversee subcontractor performance and cost controls, ensuring that any use of subcontractors and consultants is selective, strategic, and does not increase project cost.
• Own the contractor’s Quality Control Plan and continuous improvement processes; use performance data to refine processes during Phase 1 and support the transition to Phase 2.
• Safeguard sensitive healthcare information and ensure all work complies with the No Surprises Act, the Federal IDR regulations at 45 CFR 149.510, applicable HHSAR clauses, and all contract security and privacy requirements.

• Minimum of seven (7) years of relevant professional experience managing Federal and/or State contracts as a principal investigator or its equivalent.
• Demonstrated track record managing multi-year, multi-task federal engagements of similar scope, scale, and complexity — ideally healthcare compliance, program integrity, or audit programs.
• Bachelor’s degree in a relevant field (e.g., public administration, health policy, business, accounting, healthcare administration, or related discipline); advanced degree preferred.
• Proven ability to manage geographically distributed audit or compliance teams, including subcontractor oversight, performance monitoring, and corrective action.
• Excellent written and verbal communication skills, including experience briefing senior federal stakeholders and producing publication-quality reports.
• Availability and commitment to serve in the Key Personnel role for the full period of performance; a signed letter of commitment will be required at proposal submission for any candidate not already employed by the prime contractor or a proposed subcontractor.
• Ability to obtain and maintain any required CMS security and privacy clearances and to complete CMS-required training.

• Prior experience supporting CMS, HHS, DOL, or Treasury on healthcare compliance, payment integrity, or arbitration/dispute resolution programs.
• Familiarity with the Federal IDR process under the No Surprises Act, certified IDR entity operations, and the interaction between Federal requirements and specified State laws or All-Payer Model Agreements.
• PMP, PgMP, or equivalent project management credential.
• Experience leading the stand-up of new federal audit programs, including transitioning from baseline establishment to scaled, steady-state operations.