Lead Insurance Product Manager – Part D/PDP

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $115.2k - $158.4k / year

⏰ Full Time

🟠 Senior

✅ Product Manager

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Lead year-round Medicare Part D/PDP product strategy and execution • Evaluate competitive, financial, regulatory, operational and member insights to recommend portfolio actions • Develop recommendations for new or enhanced benefits, product features and market approaches • Lead annual PDP bid-cycle activities, including benefit design coordination, bid submission readiness, PBP Section Rx, HPMS, validation resolution and cross-functional alignment • Coordinate benchmark, de minimis, rebate reallocation, desk review and related PDP activities • Lead resolution of filing questions, validation findings, audit exhibits and CMS submission issues • Establish governance, decision points and controls for accurate, timely and compliant submissions • Interpret CMS guidance and Medicare Part D policy changes into product requirements and execution plans • Lead feasibility assessments across product, regulatory, actuarial, financial, pharmacy, operations, technology and member-experience functions • Lead new Part D opportunities, including CMMI demonstrations and emerging pharmacy programs, from concept through implementation • Lead annual PDP readiness through AEP and January 1 implementation • Coordinate member-facing benefit messaging, product information, digital tools, training and operational readiness • Lead PDP support for State Pharmaceutical Assistance Program requests, evaluations, contracting support and implementations • Establish standards, controls and reusable tools for PDP strategy, filings and readiness • Improve processes using data, lessons learned and root-cause analysis • Serve as business subject matter expert for automation and product-data initiatives • Provide functional leadership, coaching and subject-matter guidance without formal people-management authority • Facilitate complex decisions, communicate evidence-based recommendations and escalate material risks • Report to the Director, Insurance Product Management and serve as primary CPES lead for PDP product strategy and execution

🎯 Requirements

• Bachelor’s degree • 5+ years of relevant healthcare, health plan, Medicare, product management or related experience, including substantial Medicare Part D experience • Direct experience with standalone Prescription Drug Plans and the Medicare Part D product lifecycle • Experience leading Medicare Part D product strategy, bids, filings, benefit implementation or annual readiness activities • Ability to interpret CMS regulatory, contractual or operational guidance and translate it into product requirements, decisions and execution plans • Experience leading complex cross-functional projects, processes or work groups with minimal instruction • Ability to exercise independent judgment, analyze complex information and present clear recommendations and tradeoffs to senior leaders • Excellent written, verbal, facilitation and presentation skills • Ability to work extended hours and occasional weekends during critical CMS, bid and implementation periods • Deep hands-on experience with PDP bid submission, PBP Section Rx, HPMS, audit exhibits, benchmark, de minimis, rebate reallocation or desk review activities • Knowledge of LIS, SPAP, formulary coordination, Part D member materials and AEP readiness • Experience with competitive intelligence, CMMI demonstrations or implementation of new CMS pharmacy initiatives • Experience developing business requirements for automation, process improvement, product data or benefit-authoring tools • Experience creating governance, quality controls, metrics or reusable operating mechanisms for complex product work • Experience coaching product professionals or leading work through indirect teams • Project management, Lean or related process-improvement certification preferred

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Dedicated home workspace arrangement • Remote work with occasional travel to Humana offices for training or meetings

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