Role Overview
We are seeking a Program Manager – MSO Operations to lead and coordinate operational initiatives across a delegated MSO / IPA environment, with a strong focus on claims operations and core platforms.
This role is ideal for someone who has worked closely with EZ-CAP and/or QNXT, understands Medicare Advantage operations, and can manage cross-functional execution between operations, IT, and business teams.
This is an execution-focused role—hands-on, detail-oriented, and close to day-to-day MSO workflows.
Key Responsibilities
- Manage and drive operational programs across MSO / IPA operations, including claims and related workflows
- Lead initiatives involving EZ-CAP and/or QNXT configuration, enhancements, or operational readiness
- Act as the coordination point between claims operations, IT, vendors, and business stakeholders
- Ensure claims-related changes align with:
- Medicare Advantage requirements
- Provider contracts and fee schedules
- Delegated and compliance obligations
- Own program plans, timelines, dependencies, and risk tracking
- Support testing, UAT, and go-live activities for operational or system changes
- Monitor execution to ensure minimal disruption to ongoing claims and operational processes
- Prepare clear status updates, risks, and issue escalations as needed
Required Experience & Skills
- 10+ years of experience in healthcare operations or program management
- Direct experience working in MSO, IPA, or managed care environments
- Hands-on experience with EZ-CAP and/or QNXT (required)
- Strong understanding of:
- Medicare Advantage claims operations
- Claims adjudication and payment workflows
- Provider contracts and fee schedules
- Experience coordinating across technical and operational teams
- Strong organizational, documentation, and communication skills
- Experience with delegated risk arrangements or capitation models
- Exposure to encounters, EDI (837/835), or reconciliation processes
- Prior experience supporting system implementations or upgrades
- PMP or similar program management certification
Role Details:
Location: United States (Remote / Hybrid)
Employment Type: Full-Time
