Senior Manager – Government Program Operations

🕒 vor 4 Monaten

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Capital Rx

WebsiteLinkedInAlle Stellen

501 - 1000 Mitarbeiter

Gegründet 2017

⚕️ Krankenversicherung

💳 Fintech

🤖 Künstliche Intelligenz

Healthcare Insurance • Fintech • Artificial Intelligence

Capital Rx ist das am schnellsten wachsende Healthtech-Unternehmen in Amerika, das sich der Transformation der Verschreibungspreisgestaltung und der Patientenversorgung widmet. Gegründet im Jahr 2017, bietet es innovative Dienstleistungen im Bereich der Verwaltung von Apothekenleistungen (PBM), einschließlich anpassbarer Apothekenvorteile für große Arbeitgeber und einer KI-gestützten Plattform für Navigationspflege. Capital Rx konzentriert sich darauf, Kunden kostengünstige Lösungen und betriebliche Effizienz zu bieten, während es Transparenz und qualitativ hochwertige Versorgung für Patienten gewährleistet.

Beschreibung

• Lead Government Programs support for Exchange business functions including claims adjudication, regulatory reporting, and audit support (Government, and Client). • Leads the interpretation, implementation and monitoring of all relevant regulatory requirements and changes impacting Capital Rx’s Exchange Programs. • Establish and maintain the EDGE pharmacy submission playbook (file intent, lineage, duplicate controls, timestamp standards, enrollment alignment). • Define and enforce submission cadences, pre‑submission QA gates, and accept/active/non‑orphan targets that meet CMS sufficiency timelines. • Translate CMS updates into operational SOPs and training. • Partners with cross‑functional SMEs to analyze regulatory changes, determine their implications for organizational processes, systems, and client commitments, and leads the coordinated, on‑time implementation of required updates across the enterprise. • Manages timely response to Government Programs support for RFP/RFI, internal sales, and Exchange client requests. • Provides key insights on Exchange functions using data analysis, industry knowledge and subject matter expertise to identify opportunities, and develop solutions, for optimization of internal business processes and systems. • Supports the documentation management of internal policies and procedures, reporting and project specifications, job aids, and workflows for designated Government Programs Operations. • Leverages profound knowledge of Exchange guidance and understanding of industry and market requirements to support product strategy and service delivery. • Maintains current knowledge of Exchange requirements to facilitate compliance of ongoing business operations. • Fosters a high-performance culture through mentoring and collaboration, providing team members with ongoing performance feedback and identifying required changes to existing roles and responsibilities to ensure effectiveness and efficiency. • Assesses impact of new business to understand scalability and staffing needs.

🎯 Anforderungen

• 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange plans • 5+ years people management experience • Vast knowledge of Exchange regulatory requirements and associated product and/or operational workflows • Proven success managing multiple complex projects simultaneously • Extremely flexible, highly organized, and able to shift priorities easily • Attention to detail & commitment to delivering high quality work product • Excellent written and verbal communication skills • Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities

🏖️ Vorteile

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work options