Job Description

Company

Navitus

About Us

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. We are committed to removing cost from the drug supply chain to make medications more affordable for the people who need them. At Navitus, our team members work in an environment that celebrates diversity, fosters creativity and encourages growth. We welcome new ideas and share a passion for excellent service to our customers and each other._____________________________________________________________________________________________________________________________________________________________________________________________________________. Current associates must use SSO login option at https://employees-navitus.icims.com/ to be considered for internal opportunities. ____________________________________________________We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $79,872.00 - USD $98,003.00 /Yr.

STAR Bonus % (At Risk Maximum)

7.50 - Salaried Non-Management except pharmacists

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Remote Work Notification

ATTENTION: Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

Overview

Navitus Health Solutions is seeking a Product Manager (PM) to join our team!

This position is responsible for providing product management for the Navitus Medicare Part D program. The Product Manager (PM) will lead efforts to design, develop, implement, and oversee various Medicare Part D processes that support both regulatory requirements and client expectations to ensure Navitus remains compliant with Centers for Medicare and Medicaid Services (CMS) guidance. The PM is responsible for reviewing and acting upon all CMS guidance related to these functions, including technical guidance and business process/operational guidance. The PM ensures that the appropriate software, processes/procedures, and oversight monitoring, are implemented to meet these requirements.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Develops and maintains deep subject matter expertise related to Medicare Part D rules and regulations
• Monitors and interprets CMS regulations, guidance, and system changes. Ensures the Medicare Part D function meets all regulatory requirements.
• Manages the development, implementation, and maintenance of Medicare Part D processes for all Medicare Part D clients. Develops the necessary project plans and leads projects that enhance the Medicare Part D program. Implements requirements utilizing project management tools/principles. Ensures process is stable and effective monitoring mechanisms are established.
• Performs operational oversight for services delegated to Navitus by Medicare D clients. Aligns oversight mechanisms with identified risks.
• Identifies/implements process improvements to gain efficiencies, improve automation and/or mitigate non-compliance/risk. Ensures process is scalable for future growth. Strives for “best practice” where possible.
• Actively participates in implementing corrective action to address compliance issues. Ensures the actions are correcting the root cause, preventing future reoccurrence and that appropriate detection/monitoring mechanisms are in place. Engages Medicare Compliance leadership with all non-compliance related issues and/or when obstacles arise. Supports compliance efforts including CMS audits and client oversight audits.
• Provides SME support to the organization and to Navitus’ Med D clients related to guidance interpretation; operational processes that support the Med D requirements; problem solving of issues/questions; and implementation/reimplementation support.
• Supports Sales efforts with Request for Proposal (RFP) responses specific to Medicare Part D, as needed.
• Ensures that policies and procedures exist to document that Navitus complies with all Part D/regulatory requirements. Performs oversight to ensure guidance citations are accurate and current. Conducts periodic audits to ensure the functional areas are performing duties consistent with the documented policy.
• Other duties as assigned

Qualifications

What our team expects from you?

• Bachelor’s degree or equivalent work experience in Medicare Part D required
• 3 years of Medicare Part D experience required
• Expertise in Medicare Part D regulations and demonstrated accountabilities in areas such as coverage determinations, appeals and grievances, prior authorizations, formulary management, transition monitoring, etc. is preferred
• Experience in government program compliance oversight and CMS audit protocol highly desired
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• 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!

#LI-Remote

Location : Address

Remote

Location : Country

US