PBM- Government Programs Operations Manager

• Position ID #: PBM030325OPS
• Location: Various Cities
• Required Education: Bachelor's Degree
• Salary Range: $90,000 - $100,000
• Required Experience: Five to Seven Years (5-7)
• Commission Range: N/A
• Other: Bonus, Benefits
• Required Travel: N/A
• Relocation: N/A
• 
  Description:
  Rapidly Growing Player in the Pharmacy Benefits Management (PBM) marketplace seeks a Government Programs Operations Manager is instrumental in ensuring the compliant and efficient administration of pharmacy benefits within the framework of ever-evolving Medicare regulatory landscapes.
  
  Some of the expected job functions include:
  • Review contract and regulatory language to extract points requiring action or needing development work to maintain compliance
  • Maintain current knowledge of Medicare requirements to facilitate compliance of ongoing business operations
  • Monitor internal government program operations to identify gaps and/or resolve any identified operational discrepancies, including root cause analysis and implementation of necessary actions
  • Support audits of government programs (government, client or internal)
  • Perform highly complex data analysis to ensure implemented solutions are functioning according to defined specifications
  • Document policies and procedures, reporting and project specifications, job aids and workflows within the department
   
  The compensation plan includes a competitive salary ($90,000 - $100,000 - d/o/e), plus bonus and benefits.
  This position can be filled “remotely”, or as “hybrid”, should the candidate live in the NYC-Metro area.
• 
  Requirements:
  The ideal candidate for this position has at least six (6) years of documented Operations Management success in the Managed Care Industry, (with STRONG preference for the PBM market), supporting Medicare lines of business.
  • 4+ years of relevant PBM and/or Health Plan experience supporting Medicare  programs within the domain of pharmacy benefits
  • Thorough knowledge of Medicare regulatory requirements and associated product and/or operational workflows within the domain of pharmacy benefits
  • Knowledge of relevant tools such as the Microsoft (MS) Office suite of product, MS Visio, JIRA, Confluence, etc.
  • Experience leveraging analytical tools such as SQL, R, or Python to analyze data
  • Familiarity with state pharmacy encounter submissions
  • Excellent written and verbal communication skills
  • Strong analytical, problem-solving, and critical thinking skills
  • Familiarity with the Agile software development methodology
  Preferred Qualifications:
  • 6+ years of relevant PBM and/or Health Plan experience supporting Medicare programs within the domain of pharmacy benefits
  • Thorough knowledge of Medicare  regulatory requirements and associated product and/or operational workflows within the domain of pharmacy benefits
  • Knowledge of HEDIS and Risk-Adjustment/RxHCC methodologies
  
  Qualified candidates should send their resumes in MS Word format to: mail@phoenixhealthsearch.com