Medicaid Pharmacy Network Program Manager - Remote

Primary Responsibilities

• Lead the design and implementation of the operating model, processes and governance required to support Medicaid regulatory adherence within Network Relations
• Partner with Medicaid subject matter experts across Regulatory Affairs, Compliance and the broader PBM organization to define strategy and design the operating model, processes, and approach for expanding Medicaid LOB regulatory support
• Establish frameworks for regulatory intake, interpretation, implementation and ongoing compliance monitoring
• Own the full lifecycle of Medicaid regulatory initiatives, including requirement intake, impact assessment, solution design, implementation, and post-implementation validation
• Develop and deliver executive-level reporting, presentations and recommendations
• Support regulatory audits, external inquiries, and state-specific escalations (e.g., Departments of Insurance, Medicaid agencies)

Required Qualifications

• 5+ years of experience leading complex, cross-functional programs in a highly matrixed healthcare or regulatory environment
• Experience interpreting and implementing regulatory, legal, or compliance requirements
• Demonstrated experience building or scaling programs, processes, or operational capabilities in ambiguous environments
• Advanced proficiency in Microsoft Office Suite (Excel, PowerPoint, Word)
• Proven ability to lead large, cross-functional initiatives with multiple stakeholders and competing priorities

Preferred Qualifications

• Experience with Medicaid programs, state-specific healthcare regulations or government healthcare lines of business
• PBM, health plan, or healthcare consulting experience including pharmacy network and reimbursement models (e.g., MAC, NADAC, AWP)
• Experience working with Legal and Regulatory Affairs teams to interpret and operationalize legislative requirements
• Experience with Agile or similar delivery methodologies
• Experience with regulatory tracking, workflow, or reporting tools (e.g., SharePoint, eGRC, Smartsheet, Tableau)