What are the responsibilities and job description for the PBM - Government Programs Operations Manager position at The PHOENIX Health Search Group?
Description
Rapidly Growing Player in the Pharmacy Benefits Management (PBM) marketplace seeks a Government Programs Operations Manager is instrumental in ensuring the compliant and efficient administration of pharmacy benefits within the framework of ever-evolving Medicaid and Exchange regulatory landscapes.
Some of the expected job functions include:
- Review contract and regulatory language to extract points requiring action or needing development work to maintain compliance
- Maintain current knowledge of Medicaid and Exchange requirements to facilitate compliance of ongoing business operations
- Monitor internal government program operations to identify gaps and/or resolve any identified operational discrepancies, including root cause analysis and implementation of necessary actions
- Support audits of government programs (government, client or internal)
- Perform highly complex data analysis to ensure implemented solutions are functioning according to defined specifications
- Document policies and procedures, reporting and project specifications, job aids and workflows within the department
The compensation plan includes a competitive salary ($90,000 - $100,000 - d/o/e), plus bonus and benefits.
This position can be filled “remotely”, or as “hybrid”, should the candidate live in the NYC-Metro area.
Requirements
The ideal candidate for this position has at least six (6) years of documented Operations Management success in the Managed Care Industry, (with STRONG preference for the PBM market), supporting Medicaid and Exchange lines of business.
- 5 years of relevant PBM and/or Health Plan experience supporting Medicaid programs within the domain of pharmacy benefits
- Thorough knowledge of Medicaid regulatory requirements and associated product and/or operational workflows within the domain of pharmacy benefits
- Knowledge of relevant tools such as the Microsoft (MS) Office suite of product, MS Visio, JIRA, Confluence, etc.
- Experience leveraging analytical tools such as SQL, R, or Python to analyze data
- Familiarity with state pharmacy encounter submissions
- Excellent written and verbal communication skills
- Strong analytical, problem-solving, and critical thinking skills
- Familiarity with the Agile software development methodology
Preferred Qualifications:
- 6 years of relevant PBM and/or Health Plan experience supporting Medicaid and Exchange programs within the domain of pharmacy benefits
- Thorough knowledge of Medicaid and Exchange regulatory requirements and associated product and/or operational workflows within the domain of pharmacy benefits
- Knowledge of HEDIS and Risk-Adjustment/RxHCC methodologies
Qualified candidates should send their resumes in MS Word format to: mail@phoenixhealthsearch.com
Salary : $90,000 - $100,000