Manager, Government Programs (EGWP)

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including Judi Rx (a public-benefit PBM for self-insured employers), Judi Health™ (full-service health-benefit management), and Judi®, the industry’s leading Enterprise Health Platform that consolidates all claim-administration workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in U.S. healthcare.

About the role

The Government Programs EGWP Manager is responsible for implementation, operational oversight, and change management of regulatory requirements for the Health Plan EGWP line of business. This role manages daily activities and ongoing oversight of Medicare Part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP) operations to ensure compliance with CMS regulations while meeting employer, member, and financial objectives.

Responsibilities

• Manage EGWP program setup, implementation, and go-live readiness across internal functions, including claims processing, clinical programs, STARs, and audits.
• Provide day-to-day management to operations analysts for EGWP.
• Oversee and monitor financial performance, operational KPIs, and CMS compliance metrics for PBM claims, formulary, coverage determinations, appeals, and grievances (CDAG).
• Manage issue resolution and corrective actions with related first-tier and downstream entities (FDRs).
• Perform outreach on plan-to-plan activities, FIR transaction corrections, and other financial transactions requiring Health Plan interventions.
• Lead regulatory reporting to ensure timely and accurate submissions from internal and external resources as required by the Health Plan, State, and CMS.
• Collaborate cross-functionally on employer group issues, communications, and oversight of Health Plan functions performed by employer groups or delegates.
• Support internal and external audits by federal and state agencies, including audit preparation, documentation, issue response, and remediation tracking.
• Develop compliant documentation for operational areas, including policies, procedures, workflows, and work instructions.
• Support Health Plan team with member communications, enrollment, member services oversight, and other functions as needed.

Requirements

• Minimum of HS diploma/GED or equivalent experience.
• 5+ years of Medicare Part D and/or EGWP experience.
• Deep knowledge of Medicare Part D claim processing requirements, CDAG oversight and monitoring, and Health Plan Part D reporting.
• Experience working in a delegated and highly matrixed organization.
• Strong operational acumen.

Qualifications

• Health Plan Medicare Part D and/or EGWP experience.
• Experience working within CMS systems, including HPMS and MARx.
• Experience with CMS, CMS Contractor, and State Audits.
• Strong analytical acumen.

Pay

• New York, NY: $128,000 – $160,000 USD
• Denver, CO: $117,600 – $147,000 USD
• Charlotte, NC: $106,800 – $133,500 USD

Schedule

Hybrid (local to NYC, Denver, CO, or Charlotte, NC).