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)

5.00 - 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 unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.

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

The Medicaid Product Manager (MPM) will be responsible for providing regulatory support for the Navitus Medicaid program. The Product Manager (MPM) will facilitate efforts to develop and implement various Medicaid process changes according to the requirements defined by the Center for Medicare and Medicaid Services (CMS) and each State regulating entity. The MPM is responsible for reviewing and acting upon all CMS and State guidance related to these functions, including technical guidance as well as business process-related guidance. The MPM must work closely with all key functional areas that administer certain Medicaid functions, including but not limited to Implementation, Formulary Administration, Provider Services, Clinical and Client Services departments.

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 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

Qualifications

What our team expects from you?

• 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
• 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
• 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