Product Manager, Medicaid

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. 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.

About the role

The Medicaid Product Manager (MPM) will provide regulatory support for the Navitus Medicaid program, facilitating the development and implementation of Medicaid process changes according to requirements defined by the Center for Medicare and Medicaid Services (CMS) and each State regulating entity. The MPM will review and act upon all CMS and State guidance, working closely with key functional areas such as Implementation, Formulary Administration, Provider Services, Clinical, and Client Services departments.

Responsibilities

• 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
• Provides operational oversight of the Navitus Managed Medicaid product line, including 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 and maintenance of product documentation, including training materials
• Assists the Program Manager in reviewing and managing updates to State contracts, ensuring content aligns with agreed-upon services and regulations
• Develops and continually evaluates Government Program Operations functions, monitoring work product measures/targets including turn-around times and accuracy
• Other duties as assigned

Requirements

• 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 and relationship-building in healthcare or a related environment
• 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 is a plus
• Ability to participate in, adhere to, and support compliance program objectives
• Ability to consistently interact cooperatively and respectfully with other employees

Benefits

• 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

Pay

USD $79,872.00 - USD $98,003.00 per year, plus a 5% STAR Bonus (At Risk Maximum)

Schedule

Monday through Friday, 8:00 AM to 5:00 PM

Remote work is not available to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.