Clinical Program Manager – CMS Medical Review

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Simsy Ventures

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B2B • Startup • Sustainability

Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.

11 - 50 employees

Founded 2022

🤝 B2B

📋 Description

• Serve as the contractor’s authorized representative on all daily operational matters. • Maintain ongoing communication with the CMS RVC COR regarding contract performance, staffing, and deliverables. • Oversee medical review activities and ensure compliance with CMS guidelines and FFS RAC Program requirements. • Lead cross-functional teams and manage staff required to support RVC operations. • Ensure accurate interpretation of Medicare coverage, documentation, and regulatory standards. • Monitor project progress, performance measures, and quality assurance outputs. • Prepare operational updates, reports, and data summaries for CMS and internal leadership. • Ensure effective workflows, staffing coverage, and adherence to deadlines and contract terms. • Provide clinical oversight and guidance across medical review tasks and methodologies.

🎯 Requirements

• 5+ years of Program Management experience overseeing large or complex healthcare projects. • Experience in medical review, healthcare auditing, or clinical review operations. • Extensive knowledge of the Medicare program, including CMS regulatory and operational requirements. • Working knowledge of the CMS FFS RAC Program. • Strong leadership abilities with experience managing multidisciplinary teams.

🏖️ Benefits

• Competitive compensation and benefits package