Infinite Computer Solutions
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Position Summary Program Director, Government Programs
Job Description The Program Director, Government Programs is Zyter’s senior strategic leader responsible for the design, oversight, and success of all CMS and government-sponsored initiatives, including the WISe-R model and future federal or state programs. This role sets the strategic direction, ensures governance and compliance, manages CMS relationships, and oversees all delegated clinical and operational components. The Program Director provides top-level leadership and decision‑making while delegating day‑to‑day program activities, reporting, escalations, and quality monitoring to the Program Manager and broader operational teams. This leader ensures Zyter’s government programs operate with excellence, transparency, and accuracy across clinical, operational, technical, and AI‑enabled workflows.
Key Responsibilities
Strategic Leadership and Program Direction
Establish the strategic vision, operating model, and governance framework for WISe‑R and all future CMS or state government programs.
Translate CMS model requirements into strategic priorities, investment needs, staffing plans, and cross‑functional roadmaps.
Serve as the decision‑maker for government program policy interpretation, risk posture, and long‑term direction.
CMS and Government Relationship Management
Act as Zyter’s senior representative with CMS, CMMI, MACs, state agencies, and federal partners.
Lead high‑level discussions on program expectations, compliance posture, AI governance, quality standards, and operational readiness.
Represent Zyter during CMS audits, check‑ins, onsite reviews, and program monitoring sessions.
Governance, Compliance, Accreditation, and Delegation Oversight
Establish and oversee the governance structure for all government programs, ensuring alignment with CMS rules, NCQA and URAC standards, and Zyter compliance requirements.
Lead oversight of Zyter’s clinical partner organizations and delegated entities, ensuring accountable, compliant performance.
Ensure end‑to‑end audit readiness and serve as the executive sponsor for corrective action planning.
Cross‑Functional Leadership and Enterprise Alignment
Work closely with Product, Engineering, AI Governance, Operations, Clinical Leadership, Analytics, Implementation, and Account Management to align strategy, workflows, and resourcing.
Provide senior leadership guidance on AI‑enabled UM, CM, and DM workflows to ensure safe, compliant, and transparent program execution.
Drive organizational readiness for new government initiatives, including future CMS models, grants, pilots, or multi‑state implementations.
Performance Oversight and Executive Reporting
Set performance expectations, KPIs, contractual and regulatory targets, and quality standards for each government program.
Oversee program scorecards, dashboards, CMS‑required reporting, utilization trends, financial performance, and outcomes.
Provide executive‑level updates to Zyter leadership, including risks, opportunities, lessons learned, and strategic recommendations.
Leadership of Program Manager and Operational Staff
Supervise the Program Manager, Government Programs, who manages day‑to‑day operations, reporting, provider escalations, quality review, and operational troubleshooting.
Provide strategic guidance, remove barriers, and ensure the Program Manager has the resources needed to execute.
Serve as the escalation point for high‑severity issues requiring senior judgment, policy interpretation, or CMS engagement.
AI Governance and Innovation Alignment
Partner with Zyter’s Responsible AI Governance program to ensure government program workflows adhere to transparency, safety, fairness, and model monitoring requirements.
Lead discussions on how AI influences clinical decision support, workflow orchestration, efficiency, and program outcomes.
Ensure government programs are early testbeds for AI governance best practices.
Qualifications
Bachelor’s degree required; advanced degree in public health, health administration, nursing, policy, or business preferred.
Ten or more years of leadership experience in CMS programs, government contracting, payer operations, or large‑scale UM or CM organizations.
Deep expertise in CMS regulations, government pilot programs, UM and CM operations, NCQA and URAC standards, delegation oversight, and regulatory reporting.
Proven success engaging with CMS and federal agencies at an executive level.
Experience leading complex programs with both operational and clinical components, including oversight of external delegated entities.
Strong capacity for strategic planning, regulatory interpretation, risk management, and organizational change leadership.
Ability to lead through influence and mobilize cross‑functional teams across clinical, technical, operational, and AI domains.
Executive presence, exceptional communication skills, and comfort representing Zyter in high‑stakes regulatory environments.
Seniority Level: Director
Employment Type: Full‑time
Job Function: Product Management and Marketing
Industries: IT Services and IT Consulting
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Position Summary Program Director, Government Programs
Job Description The Program Director, Government Programs is Zyter’s senior strategic leader responsible for the design, oversight, and success of all CMS and government-sponsored initiatives, including the WISe-R model and future federal or state programs. This role sets the strategic direction, ensures governance and compliance, manages CMS relationships, and oversees all delegated clinical and operational components. The Program Director provides top-level leadership and decision‑making while delegating day‑to‑day program activities, reporting, escalations, and quality monitoring to the Program Manager and broader operational teams. This leader ensures Zyter’s government programs operate with excellence, transparency, and accuracy across clinical, operational, technical, and AI‑enabled workflows.
Key Responsibilities
Strategic Leadership and Program Direction
Establish the strategic vision, operating model, and governance framework for WISe‑R and all future CMS or state government programs.
Translate CMS model requirements into strategic priorities, investment needs, staffing plans, and cross‑functional roadmaps.
Serve as the decision‑maker for government program policy interpretation, risk posture, and long‑term direction.
CMS and Government Relationship Management
Act as Zyter’s senior representative with CMS, CMMI, MACs, state agencies, and federal partners.
Lead high‑level discussions on program expectations, compliance posture, AI governance, quality standards, and operational readiness.
Represent Zyter during CMS audits, check‑ins, onsite reviews, and program monitoring sessions.
Governance, Compliance, Accreditation, and Delegation Oversight
Establish and oversee the governance structure for all government programs, ensuring alignment with CMS rules, NCQA and URAC standards, and Zyter compliance requirements.
Lead oversight of Zyter’s clinical partner organizations and delegated entities, ensuring accountable, compliant performance.
Ensure end‑to‑end audit readiness and serve as the executive sponsor for corrective action planning.
Cross‑Functional Leadership and Enterprise Alignment
Work closely with Product, Engineering, AI Governance, Operations, Clinical Leadership, Analytics, Implementation, and Account Management to align strategy, workflows, and resourcing.
Provide senior leadership guidance on AI‑enabled UM, CM, and DM workflows to ensure safe, compliant, and transparent program execution.
Drive organizational readiness for new government initiatives, including future CMS models, grants, pilots, or multi‑state implementations.
Performance Oversight and Executive Reporting
Set performance expectations, KPIs, contractual and regulatory targets, and quality standards for each government program.
Oversee program scorecards, dashboards, CMS‑required reporting, utilization trends, financial performance, and outcomes.
Provide executive‑level updates to Zyter leadership, including risks, opportunities, lessons learned, and strategic recommendations.
Leadership of Program Manager and Operational Staff
Supervise the Program Manager, Government Programs, who manages day‑to‑day operations, reporting, provider escalations, quality review, and operational troubleshooting.
Provide strategic guidance, remove barriers, and ensure the Program Manager has the resources needed to execute.
Serve as the escalation point for high‑severity issues requiring senior judgment, policy interpretation, or CMS engagement.
AI Governance and Innovation Alignment
Partner with Zyter’s Responsible AI Governance program to ensure government program workflows adhere to transparency, safety, fairness, and model monitoring requirements.
Lead discussions on how AI influences clinical decision support, workflow orchestration, efficiency, and program outcomes.
Ensure government programs are early testbeds for AI governance best practices.
Qualifications
Bachelor’s degree required; advanced degree in public health, health administration, nursing, policy, or business preferred.
Ten or more years of leadership experience in CMS programs, government contracting, payer operations, or large‑scale UM or CM organizations.
Deep expertise in CMS regulations, government pilot programs, UM and CM operations, NCQA and URAC standards, delegation oversight, and regulatory reporting.
Proven success engaging with CMS and federal agencies at an executive level.
Experience leading complex programs with both operational and clinical components, including oversight of external delegated entities.
Strong capacity for strategic planning, regulatory interpretation, risk management, and organizational change leadership.
Ability to lead through influence and mobilize cross‑functional teams across clinical, technical, operational, and AI domains.
Executive presence, exceptional communication skills, and comfort representing Zyter in high‑stakes regulatory environments.
Seniority Level: Director
Employment Type: Full‑time
Job Function: Product Management and Marketing
Industries: IT Services and IT Consulting
#J-18808-Ljbffr