Job Description
A bit about this role:
The Part D Implementation Program Manager is a key member of the Pharmacy Operations team. In this role, the Manager reports directly to the Sr. Program Manager, Pharmacy, and works collaboratively with the Program Manager, Sr. Pharmacy Program Associate, and the Pharmacy Program Associate. A core focus of the position is partnering with the Pharmacy Benefit Manager (PBM) and other vendor partners to implement new and existing CMS and other delegated Part D Programs.
Your Responsibilities and Impact will include:
Complete oversight of all implemented CMS Part D Program functions delegated to the PBM
Collaborate with internal stakeholders for annual new and existing plan implementation as well as CMS Part D Program functions.
Coordinates with Compliance department on Part D oversight
Act as a liaison to address operational Part D issues including documenting issues, identifying owner, routing issue, gathering impact, and corrective action steps
Devoted Health Part D subject matter expert to assist internal and external partners to resolve any questions or concerns around Part D benefits and pharmacy claim adjudication through implementation and welcome season
Maintains knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e.g., CMS,HPMS memos) applicable to Part D specifically and general knowledge of Medicare Advantage requirements
Drafts and maintains policies and procedures, standard operating procedures, and work instructions for implementation projects
Required skills and experience:
3 years plus experience in pharmacy operations at a health plan or pharmacy benefit manager (PBM)
Strong initiative and ability to process improve
Data analysis and strong Excel/Sheets experience
Strong understanding of CMS Guidance and HPMS(Health Plan Management System) Memo guidance updates
Desired skills and experience:
Understanding of Pharmacy Benefit Management Medicare Requirements Document
Ability to review excel Pharmacy Benefit manager Testing Files.
Ability to accurately update the Pharmacy Benefit Manager letter document file Master Data Grid
Complete timely review, update and approval of all delegated Pharmacy Benefit Manager letters
Ability to review HPMS Memo guidance and apply guidance to the needs of annual implementation and implementation of new CMS programs
Experience in Medicare Part D Operations is preferred
Salary range: $76,000 - $120,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce.
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.