Program Manager

Position Summary:

This role is accountable for the installation, change management and oversight of Medicare, Medicaid and Exchange operations using research, analysis, testing and validation as tools. The MPPP Manager will focus primarily on end-to-end ownership and management of the Medicare Prescription Payment Plan (MPPP) program through collaboration with internal stakeholders and Medicare clients to deliver on the business goals and comply with applicable regulatory requirements ensuring our internal processes/system capabilities meet regulator and client intent.

Position Responsibilities:

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  Collaborate with implementation and project managers on the implementation and onboarding of Medicare Prescription Payment Plan (MPPP) clients, ensuring alignment with contract terms and CMS guidelines.

  
  
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  Lead the interpretation and operational implementation of regulatory & sub-regulatory guidance, coordinating tasks & workplans across impacted operational departments

  
  
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  Develop and manage all MPPP documents, policies and procedures, reporting, project plans, job aids, workflows, etc.

  
  
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  Serve as the primary point of contact for internal and external stakeholders regarding MPPP operations.

  
  
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  Monitor internal operations and lead resolution of any identified errors, including root cause analysis and the development and implementation of necessary actions

  
  
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  Coordinate cross-functional teams to support the successful execution and oversight of MPPP activities.

  
  
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  Identifies opportunities for improvement and participates in the development of new solutions/capabilities in support of government program compliance and audit readiness

  
  
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  Responsible for adherence to the Capital Rx Code of Conduct, including reporting of noncompliance.

  
  

Minimum Qualifications:

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  5+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D

  
  
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  Experience with CMS Medicare Prescription Payment Plan operational and regulatory requirements

  
  
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  Thorough knowledge of Medicare regulatory requirements and associated product and/or operational workflows

  
  
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  Advance process and project management skills and corresponding toolsets (i.e. Jira, Confluence, Scribe, Lucid, etc.)

  
  
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  MS Excel Skills - ability to create/maintain pivot table, forms, and formula's (i.e. vlookup, true, if, left, etc)

  
  
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  Ability to balance multiple complex projects simultaneously

  
  
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  Extremely flexible, highly organized, and able to shift priorities easily

  
  
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  Attention to detail & commitment to delivering high quality work product

  
  
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  Excellent written and verbal communication skills