Operations Manager, Medicare Part D

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Operations Manager oversees operations related to our Medicare Part D program, including the Medicare Prescription Payment Program, and drive annual readiness and expansion initiatives. This individual contributor will manage day-to-day operations, optimize workflows, and ensure compliance with CMS regulations. This role will also collaborate with internal leadership, business owners, PBM partners, and key stakeholders to enhance pharmacy services and improve operational efficiencies.

Job Duties/Responsibilities:

1. Responsible for oversight and management of the Medicare Prescription Payment Pro-gram. 

2. Implement various programs and initiatives to support Pharmacy department and organizational goals. Support development of project plans and optimization of operational workflows.

3. Manage Part D annual readiness and expansion activities. Collaborate with Product team on Part D application and bid submissions to CMS. Support build of pharmacy benefits in PBM system.

4. Manage the development, preparation, and quality control of Part D member materials, including the Annual Notice of Change (ANOC), Evidence of Coverage (EOC), and Summary of Benefits.

5. Resolve issues arising from operations and coordination with internal and external stake-holders and vendors. 

6. Work cross functionally to ensure seamless operations and optimal member support.

7. Ensure compliance with regulatory requirements and support compliance program objectives.  

8. Develop process documentation, policies and procedures, and training materials.

9. Assist with SOX documentation requirements and audit support.

10. Other duties as assigned. 

Job Requirements:

Experience:

• Required: A minimum of 5 years related experience in an MAPD plan, PBM, or IPA required

• Preferred: 3 years in a operations management role
Education:

• Required: Bachelor's degree in a relevant field (e.g., Healthcare Administration, Business Administration, Pharmacy, or Public Health,)

• Preferred: Master’s degree (MBA, MHA, MPH)
Specialized Skills:

Required:

• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.

• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.

• Attention to Detail: Ensures accuracy and compliance in all Medicare Part D documentation and processes, with a strong focus on quality control and thoroughness.

• Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly

• Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.

• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.

• Project Management Skills: Ability to work cross-functionally to ensure project goals are met.  Capable of adjusting project plans and strategies in response to changing circumstances and stakeholder needs.

Licensure:

• Required: None

Other:

Required: Occasional onsite travel to the corporate office in Orange, CA may be required. Candidates should be prepared to travel up to 10% of the time to meet business needs.

Targeted salary is $100,000 with $20k equity

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2.The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $85,696.00 - $128,543.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $85,696 - $128,543