Navitus

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.

USD $98,384.00 - USD $122,980.00 /Yr.

M-F 8am to 5pm

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

Navitus Health Solutions is seeking a Sr. Product Manager, Medicaid to join our Government Programs department! 

 

The Sr. Product Manager, Medicaid (SPM) will lead efforts to design, develop, and implement various Medicaid software and associated process changes according to requirements defined by the Centers for Medicare and Medicaid Services (CMS) and each State regulating entity. The PM is responsible for reviewing and acting upon all CMS and State guidance related to these functions, including technical guidance as well as business process-related guidance. The PM ensures that the appropriate software, processes, and procedures are implemented to meet these requirements. The PM must work closely with all key functional areas that administer the Medicaid function. The PM may also administer certain Medicaid functions. Additionally, the SPM will be responsible for direct management of staff assigned to them. This includes mentoring, providing guidance, training, performance reviews, managing PTO and other such managerial tasks. The SPM will ensure assigned staff are appropriately qualified and trained and will be responsible for performance management including achievement of defined competencies.

 

Is this you? Find out more below!

How do I make an impact on my team? 

• Develops and maintains deep subject matter expertise related to CMS and State Medicaid requirements for provider materials, formulary / PDL, coverage determinations, grievances and appeals, FWA, customer care and pharmacy helpdesk, MIS / IT, third party liability, 340B, rebates, and reporting
• Manages the development, implementation, and maintenance of Medicaid software processes for all Managed Medicaid clients. Develops the necessary project plans and leads projects that enhance the Medicaid infrastructure
• Responsible for operational oversight of the Navitus Managed Medicaid product line. Provides direct functional support for required reporting and provider/member materials. Provides support for other Navitus departments as needed. Coordinates all operational and compliance related items with Managed Medicaid business partner
• Provides product support for client implementations and re-implementations. Provides SME support to Navitus Client and Clinical Services Executives representing the client
• Provides oversight for issue resolution. Engages the Program Manager with all non-compliance related issues and/or when obstacles arise. Drafts and leads the execution of performance improvement plans or corrective action plans to address. Leads compliance efforts including State, CMS audits and client delegation audits
• Supports Sales force with RFP responses specific to Medicaid operational responses. May participate in finalist presentations
• Contributes to strategy, goal setting and policy administration plans for the Medicaid function. Develops and maintains product documentation, including training materials. Develops, modifies, and improves business processes and policies through P&P’s
• Assists the Program Manager in reviewing and managing updates to State contracts, ensuring content is in line with agreed upon services and regulations
• Responsible for managing, organizing, leading, and supervising the daily operations of the assigned Associate Product Manager and Product Manager I roles
• Develop and continually evaluate Government Program Operations functions, while monitoring work product measures/targets including turnaround times and accuracy
• Other duties as assigned

What our team expects from you?

• A minimum of a Bachelor’s Degree or equivalent work experience is required
• Additional background in business or healthcare administration is desired
• Five to eight years of relevant experience in administering health insurance programs strongly desired
• Experience and expertise in new product development, product management, project management and business analysis with a “track record” of tangible success, including leadership and team collaboration/relationship-building/management in a health care or related environment is essential. Possess working knowledge of California Medicaid (Medi-Cal) regulations, standards, and processes
• Direct extensive knowledge and experience with government programs, particularly Managed Medicaid product management and program content preferred
• Familiarity with understanding and communicating complex and contradictory state and federal law, regulations or guidance is also advantageous
• California Medicaid (Medi-Cal) pharmacy experience highly desired
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

 

We are 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.

Remote

US