Head of Products - Remote

Navitus Health Solutions, LLC • Remote (Madison, Wisconsin, United States) • $0 / year • 13h ago

Navitus - Putting People First in Pharmacy - Navitus was founded as an alternative to traditional pharmacy benefit manager (PBM) models. 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._____________________________________________________________________________________________________________________________________________________________________________________________________________. 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. STAR Bonus % (At Risk Maximum) M-F 8am to 5pm

Remote Work Notification Navitus is only able to offer remote work to residents of Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington DC, Wisconsin.

The Product Manager (PM) will lead efforts to design, develop, implement, and oversee various Medicare Part D processes that support both regulatory requirements and client expectations to ensure Navitus remains compliant with Centers for Medicare and Medicaid Services (CMS) guidance. The PM is responsible for reviewing and acting upon all CMS guidance related to these functions, including technical guidance and business process/operational guidance. The PM ensures that the appropriate software, processes/procedures, and oversight monitoring, are implemented to meet these requirements. Monitors and interprets CMS regulations, guidance, and system changes. Ensures the Medicare Part D function meets all regulatory requirements. Manages the development, implementation, and maintenance of Medicare Part D processes for all Medicare Part D clients. Develops the necessary project plans and leads projects that enhance the Medicare Part D program. Implements requirements utilizing project management tools/principles. Ensures process is stable and effective monitoring mechanisms are established. Aligns oversight mechanisms with identified risks. Identifies/implements process improvements to gain efficiencies, improve automation and/or mitigate non-compliance/risk. Ensures the actions are correcting the root cause, preventing future reoccurrence and that appropriate detection/monitoring mechanisms are in place. Supports compliance efforts including CMS audits and client oversight audits. and implementation/reimplementation support. Ensures that policies and procedures exist to document that Navitus complies with all Part D/regulatory requirements. Conducts periodic audits to ensure the functional areas are performing duties consistent with the documented policy. Bachelor’s degree or equivalent work experience in Medicare Part D required ~Expertise in Medicare Part D regulations and demonstrated accountabilities in areas such as coverage determinations, appeals and grievances, prior authorizations, formulary management, transition monitoring, etc. Experience in government program compliance oversight and CMS audit protocol highly desired ~ Top of the industry benefits for Health, Dental, and Vision insurance ~9 paid holidays ~Adoption Assistance Program ~ Flexible Spending Account ~ Educational Assistance Plan and Professional Membership assistance ~ Referral Bonus Program – up to $750!

#LI-Remote Remote

Location : Country