Associate Director Managed Care Operations

Location: Morristown, NJ

About the role

The Associate Director of Managed Care Operations is a key operational role responsible for supporting and advancing the operational, regulatory, and technological functions within Managed Care Operations. This position plays an important role in helping ensure the organization's compliance with federal programs, driving process improvements, and contributing to high-priority strategic initiatives that impact financial performance and operational efficiency. The Associate Director will serve as a lead contributor for the CMS Maximum Fair Price (MFP) initiative—a high-visibility federal program spanning design through execution—supporting the development of internal process architecture, helping define business requirements, and taking ownership of day-to-day operations post-launch. Additionally, this role includes designing and implementing an end-to-end process for managed care invoice prefunding with Pharmacy Benefit Managers (PBMs), helping establish this function and serving as a subject matter expert for prefunding workflows and financial controls. The Associate Director will help advance the application of Artificial Intelligence to drive operational efficiency within Managed Care Operations, supporting the development of AI-powered solutions for formulary validation and identifying opportunities to enhance invoice processing workflows. This role involves assessing emerging technologies, contributing to business cases for AI adoption, and partnering with IT and Data Science teams to help translate innovative concepts into measurable business value. Beyond these core initiatives, the Associate Director will support the migration to the new Validata platform, manage processing and reporting for all four CMS Inflation Reduction Act (IRA) programs, and play a role in developing team talent and supporting operational continuity across the function. A strong cross-functional collaborator, the Associate Director will work closely with Treasury, Finance, Legal, Strategic Pricing, Government Pricing, Digital, Contract Development, and Account Management teams to align on priorities and deliver measurable results. Success in this role requires solid managed care industry expertise, strong analytical and regulatory acumen, excellent organizational skills, and the ability to manage through change in a fast-paced, dynamic environment. Join the team transforming care for people with immune challenges, rare diseases, cancers, and Specialty Care neurological conditions. In Specialty Care, you’ll help deliver breakthrough treatments that bring hope to patients with some of the highest unmet needs.

Responsibilities

• Shape MFP internal process architecture, define business requirements, and manage day-to-day program operations post-launch.
• Coordinate daily payment processing with third-party vendors and ensure ongoing compliance and financial accuracy.
• Design and implement an end-to-end PBM prefunding process with Pharmacy Benefit Managers, including frameworks for tracking, monitoring, and resolving funding discrepancies.
• Coordinate with Treasury, Finance, Account Management, and Operations on funding strategies while serving as primary subject matter expert and process lead.
• Drive tactical implementation of AI to enhance operational efficiency within Managed Care Operations, including developing AI-powered solutions for formulary validation and improving invoice processing workflows.
• Assess emerging technologies, contribute to business cases for adoption, and collaborate with IT and Data Science teams to translate innovations into measurable business value.
• Own end-to-end processing and reporting for all four CMS IRA programs while ensuring strict