Operations Manager, Medicare Part D - Navitus Health Solutions, LLC
About the Job
The Operations Manager, Medicare Part D serves as a subject matter expert in Medicare Part D EGWP product operations. This individual will plan, coordinate, and align resources to support the daily activities of the team. This position will interact with Navitus clients and internally with leadership and key subject matter experts across the organization. The Operations Manager fosters a great place to work by clearly communicating mission, goals, and expectations for team members, while recognizing individual and team achievements. In addition, the Operations Manager resolves escalated issues arising from operations and coordination with other departments. This role requires excellent verbal and written communication skills, project/product management experience, and deep knowledge of Medicare Part D rules and regulations. The Operations Manager will have direct management responsibility for staff administering Medicare Part D EGWP product operations.
Is this you? Find out more below!
Responsibilities:How do I make an impact on my team?
- Develops and maintains subject matter expertise related to all Medicare Part D regulations applicable to EGWP products. Maintains current knowledge of CMS requirements for operational functions to facilitate identification of requirements for development and assures compliant business operations.
- Provides oversight of EGWP product management operational support activities, including the annual production of member materials. Resolves escalated issues arising from operations and coordination with other departments.
- Manages a matrix of operational processes to assigned resources. Ensures detailed work instructions are developed and maintained. Manages workload of team members and continually balances priorities with available resources.
- Establish processes that are scalable and efficient. Identify key metrics to monitor the compliance and accuracy of the process establishing oversight methods that are operationally efficient and effective. Provide SME assistance when process metrics indicate possible risk to compliance or accuracy and lead any corrective action required once diagnosed.
- Leads activities related to annual plan submission of our EGWP plans to the Centers for Medicare & Medicaid Services (CMS), including being proficient in use of the HPMS system.
- Responsible for oversight of all EGWP client implementations and re-implementations.
- Evaluates group Medicare Part D existing products and competitor and industry data to improve existing processes.
- Develops and maintains subject matter expertise related to the Medicare Advantage and Part D Communications & Marketing Guidelines and general Medicare Part D topics as it relates to the content in the annual beneficiary materials.
- May lead process improvement projects focused on enhancements to our Medicare Part D EGWP product offering.
- Provides SME support to Navitus Sales Team for functions supported by the team. Provides support throughout the RFP process.
- Authors articles for internal Government Programs newsletter.
- Develops and maintains various policy & procedure documents.
What our team expects from you?
- A minimum of a Bachelor’s Degree is required
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects, and supervisory experience including hiring, training, assigning work and managing the performance of staff
- Five to seven years of experience in managing Medicare or equivalent managed care operations highly desired
- Work experience with a Medicare Advantage or Medicare Part D Plan in developing and maintaining annual member materials preferred
- Project management experience
- Experience working in a cross-functional business environment with ability to work closely with both internal and external business partners
- PBM experience, including PBM claims adjudication experience, is preferred
- Knowledge of Medicare Advantage and Part D Communications & Marketing Guidelines
- Experience articulating regulatory requirements
- Experience with interfacing with external clients
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- Top of the industry benefits for Health, Dental, and Vision insurance
- 20 days paid time off
- 4 weeks paid parental leave
- 9 paid holidays
- 401K company match of up to 5% - No vesting requirement
- Adoption Assistance Program
- Flexible Spending Account
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
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.
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