Government Programs Operations Manager

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

Position Summary:

The Government Programs Operations Manager is responsible for the installation, change management and oversight of Medicare, Medicaid and Exchange government programs using research, analysis, testing and validation as tools. This role will interpret guidance from CMS/States government in collaboration with the compliance team to deliver on the business goals and comply with federal/state regulatory requirements.

Responsibilities:

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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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  Collaborate with Compliance to oversee timely implementation of regulatory & sub-regulatory guidance, coordinating tasks & work plans across impacted operational departments

  
  
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  Manage error handling and change management for PDE/Encounters, plan finder, etc.

  
  
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  Monitor internal government programs operations and resolve any identified operational errors, including root cause analysis and the development and implementation of necessary actions

  
  
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  Support claims correction for retro-eligibility changes and COB

  
  
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  Support audits of government programs (government, client or internal)

  
  
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  Documents policies and procedures, reporting and project specifications, job aids and workflows within the department

  
  
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  Leverage deep understanding of Medicare & Medicaid market, regulatory environment to support product strategy and service delivery

  
  
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  Maintain current knowledge of Medicare & Medicaid requirements to facilitate compliance of ongoing business operations

  
  
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  Foster a high-performance culture through mentoring collaboration. Provide team members with constant and consistent performance feedback/direction. Assess impact of new business to understand scalability and staffing needs

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

Required Qualifications:

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

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

  
  
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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

  
  

Base Salary: $95,000 - $105,000

Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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