Product Manager, Medicaid

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🔥 0 minutes ago

🥔 Idaho – Remote

🥔 Idaho – Remote

💵 $79.9k - $98k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

✅ Product Manager

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Develop and maintain 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 • Facilitate and oversee implementation and maintenance of Medicaid functional processes for all Managed Medicaid clients • Monitor CMS and State regulations, guidance, and system changes • Provide operational oversight of the Navitus Managed Medicaid product line • Provide direct functional support for required reporting and provider/member materials • Support client implementations • Support compliance efforts, including State, CMS audits and client delegation audits • Support development and maintenance of product documentation, including training materials • Assist the Program Manager in reviewing and managing updates to State contracts • Develop and continually evaluate Government Program Operations functions while monitoring work product measures and targets, including turnaround times and accuracy • Work closely with Implementation, Formulary Administration, Provider Services, Clinical, and Client Services departments • Perform other duties as assigned

🎯 Requirements

• A minimum of a bachelor’s degree or equivalent work experience is required • Experience and expertise in product management, project management, and business analysis • Track record of tangible success, including team collaboration, relationship-building, and management in a health care or related environment • Two to five years of relevant experience in administering health insurance programs strongly desired • Additional background in business or healthcare administration is desired • Working knowledge of Medicaid regulations, standards, and processes is a plus • Participate in, adhere to, and support compliance program objectives • Ability to consistently interact cooperatively and respectfully with other employees

🏖️ 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! • STAR Bonus % (At Risk Maximum) 5.00