Note: The job is a remote job and is open to candidates in USA. Navitus Health Solutions is a pharmacy benefit management company focused on making medications more affordable and improving service. The Medicaid Product Manager will provide regulatory and operational support for the Managed Medicaid product line, facilitate process changes required by CMS and state entities, and collaborate with functional teams on implementation, compliance, reporting, documentation, and contract updates.
Responsibilities
- Develops and maintains deep subject matter expertise related to CMS and State Medicaid requirements for provider materials, formulary/PDL, coverage determinations, grievances and appeals, customer care and pharmacy helpdesk, third party liability, 340B, and reporting
- Facilitates and oversees the implementation and maintenance of Medicaid functional processes for all Managed Medicaid clients
- Monitors CMS and State regulations, guidance, and system changes
- Responsible for operational oversight of the Navitus Managed Medicaid product line. Provides direct functional support for required reporting and provider/member materials
- Provides product support for client implementations
- Supports compliance efforts including State, CMS audits and client delegation audits
- Supports the development of maintenance of product documentation, including training materials
- Assists the Program Manager in reviewing and managing updates to State contracts, ensuring content is in line with agreed upon services and regulations
- Develop and continually evaluate Government Program Operations functions, while monitoring work product measure/targets including turn-around times and accuracy
- Other duties as assigned
Skills
- * A minimum of a bachelor's degree or equivalent work experience is required
- * Experience and expertise in product management, project management and business analysis with a “track record” of tangible success, including team collaboration/relationship-building/management in health care or related environment is essential
- * Participate in, adhere to, and support compliance program objectives
- * The ability to consistently interact cooperatively and respectfully with other employees
- * Additional background in business or healthcare administration is desired
- * Two to five years of relevant experience in administering health insurance programs strongly desired
- * Working knowledge of Medicaid regulations, standards, and processes a plus
Benefits
- 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!
- Remote work
Company Overview