Product Manager, Med-D

Navitus Health Solutions is hiring a Product Manager to manage its Medicare Part D program. The role leads the design, development, implementation, and oversight of processes that meet regulatory requirements and client expectations, including monitoring CMS guidance and ensuring effective software, procedures, and oversight.

Responsibilities:

• Develops and maintains deep subject matter expertise related to Medicare Part D rules and regulations
• Monitors and interprets CMS regulations, guidance, and system changes. Ensures the Medicare Part D function meets all regulatory requirements
• Manages the development, implementation, and maintenance of Medicare Part D processes for all Medicare Part D clients. Develops the necessary project plans and leads projects that enhance the Medicare Part D program.  Implements requirements utilizing project management tools/principles.  Ensures process is stable and effective monitoring mechanisms are established
• Performs operational oversight for services delegated to Navitus by Medicare D clients.  Aligns oversight mechanisms with identified risks
• Identifies/implements process improvements to gain efficiencies, improve automation and/or mitigate non-compliance/risk.  Ensures process is scalable for future growth.  Strives for “best practice” where possible
• Actively participates in implementing corrective action to address compliance issues.  Ensures the actions are correcting the root cause, preventing future reoccurrence and that appropriate detection/monitoring mechanisms are in place.  Engages Medicare Compliance leadership with all non-compliance related issues and/or when obstacles arise.  Supports compliance efforts including CMS audits and client oversight audits
• Provides SME support to the organization and to Navitus’ Med D clients related to guidance interpretation; operational processes that support the Med D requirements; problem solving of issues/questions; and implementation/reimplementation support
• Supports Sales efforts with Request for Proposal (RFP) responses specific to Medicare Part D, as needed
• Ensures that policies and procedures exist to document that Navitus complies with all Part D/regulatory requirements.  Performs oversight to ensure guidance citations are accurate and current. Conducts periodic audits to ensure the functional areas are performing duties consistent with the documented policy
• Other duties as assigned

Requirements:

• Bachelor's degree or equivalent work experience in Medicare Part D required
• 3 years of Medicare Part D experience required
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees
• Expertise in Medicare Part D regulations and demonstrated accountabilities in areas such as coverage determinations, appeals and grievances, prior authorizations, formulary management, transition monitoring, etc. is preferred
• Experience in government program compliance oversight and CMS audit protocol highly desired