Director, Medicare Part D Programs

What you’ll do

In a few words…

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The Pharmacy Benefit Management Operations & Services team is the very heart of Abarca and meets that standard by running services from medication therapy management to pricing to government services and beyond. Our Director, Medicare Part D Programs, works in the Government Programs Services (GPS) team.

Reporting to the Vice President, Government Programs Services, you will lead the team of subject matter experts that serve as Program Managers within the GPS team. You will leverage your knowledge and experience to lead the team toward excellence within our Medicare Part D Programs and processes. In this role, you will employ your strong presentation and communication skills to work with other Abarcans and our clients to solve challenges and develop a #Betterway. You’ll lead the team to ensure consistency in quality, alignment with Abarca’s strategies, executing on commitments and ensuring ongoing goals are met. We’ll also rely on you to provide guidance and coaching as this team develops within their key areas.  

The fundamentals for the job…                         

• Leads the Medicare Part D Program Managers as a team.
• Effectively develops and manages team processes to assure adherence to client and Centers for Medicare and Medicaid (CMS) requirements.
• Engages directly with clients and leadership to resolve issues, present solutions, and identify opportunities.
• Identify, quantify, and communicate areas of risk and develop corrective actions.
• Owns accuracy and timely delivery of Part D Program responses, action plans and tasks.
• Directs resources in supporting client, CMS and internal requests by adjusting plans as needed to meet required deliverables.
• Conduct issue research, analysis, identification of root cause, impact analysis determination and corrective action.
• Establish effective communication between all stakeholders managing government programs and related projects.
• Create training materials and conduct training on job-related tasks.
• Identify and implement process improvements that deliver increased quality and efficiency.
• Support team development through coaching, mentorship and cultivating core competencies (e.g. knowledge and skills).

What we expect of you

The bold requirements…

• Bachelor’s Degree (In lieu of a degree, equivalent, relevant work experience may be considered.)
• 6+ years of Medicare Part D operational experience within a pharmacy benefit manager, including 3+ years of experience leading a team.
• Subject matter expertise in Medicare Part D; specific knowledge and experience in claim adjudication, PDE, COB, regulatory communications preferred.
• Experience in organizing and executing multiple investigations simultaneously within government programs or related areas.
• Experience in guiding teams in achieving client and regulatory results within a complex business environment.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)

Nice to have…

• Experience with technology platforms (e.g. experience using Tableau, Power BI or SQL).
• Experience with Medicare Part D programs: PDE, Medicare Plan Finder, COB.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  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.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”