Assoc. Product Manager, Medicaid and Exchange

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities.

Pay Range

USD $61,968.00 - USD $74,660.00 /Yr.

STAR Bonus % (At Risk Maximum)

5.00 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Remote Work Notification

ATTENTION: Navitus is unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

Overview

Navitus Health Solutions is seeking an Assoc. Product Manager, Medicaid and Exchange to join our team!

 

This position is responsible for overseeing the product development/management life cycle and tactical support of the Medicaid program for managed care clients and Exchange program for qualified health plan clients. The Assoc. Product Manager, Medicaid and Exchange (APM) provides oversight of daily operations required to support the Medicaid/Exchange program and subject matter expertise for key business functions, processes and the departments supporting Managed Medicaid/Exchange including SME support to the Implementation Team. The APM works closely with the Medicaid Product Manager (MPM) to ensure that the appropriate processes, procedures, software, and interfaces are implemented to meet Medicaid/Exchange program requirements and ensure regulatory compliance. The APM will lead various tactical projects or support the MPM focused on enhancements to the overall managed Medicaid/Exchange product domain, coordinate and monitor readiness assessments and report data validation efforts and client and/or regulatory audits. In addition, the APM tracks and reports product performance goals.

 

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team? 

• Leads tactical product development efforts and provides oversight of daily operations required to support the Medicaid and Exchange product
• Leads the annual retro-eligibility ranking process for Exchange clients, working closely with Technical Operations to ensure timeliness and completeness
• Develops general subject matter expertise related to State Medicaid requirements for member materials, IT, third party liability, 340B, rebates, and reporting
• Provides Medicaid/Exchange SME support to Implementation Team for new client implementations and coordinates the process for implementing new plan benefit design changes that occur after initial implementation. Works closely with the ADMEO for the annual Exchange QHP application/certification process
• Coordinates the development, implementation, and maintenance of Medicaid/Exchange software processes and interfaces for all managed Medicaid clients and Exchange clients. Leads the Exchange JSON file delivery requirement
• Ensures the Exchange function meets all regulatory requirements. Works closely with functional teams to ensure that appropriate processes are being adhered to in order to comply with Exchange program requirements
• Supports readiness assessments, data validation efforts and client and/or regulatory audits
• Tracks, monitors, analyzes, and reports product performance goals including data and processing quality, mandated reports, and compliance. Leads Federal Exchange “Transparency in Coverage” annual reporting requirements/processes
• Develops, modifies, and improves business processes and policies needed to support the Medicaid/Exchange program
• Other duties as assigned

Qualifications

What our team expects from you?

• A minimum of a bachelor’s degree in Business, Health Care Administration, or closely related field is desired
• Experience and expertise in supporting operational projects with a “track record” of tangible success, including team collaboration/relationship-building is essential. Knowledge and experience with government programs, particularly Medicaid/Exchange products content desired
• Participate in, adhere to, and support c