Government Programs Manager

Abarca Health • San Juan, PR

18h • Hybrid

About The Position

The Government Programs Manager serves as an internal subject matter expert for government-driven healthcare programs, with a primary focus on the Retiree Drug Subsidy (RDS). The role oversees the accurate, timely, and compliant administration of RDS services for clients and translates CMS guidance, technical specifications, submission requirements, and program changes into business processes, system requirements, operational controls, and monitoring programs.

The manager connects claims, eligibility, financial data, technology, operations, clients, and CMS requirements to support complete and accurate program execution. The position works across internal teams, clients, vendors, CMS, and auditors to implement initiatives, monitor performance, assess risks, improve processes, and support audits and corrective actions. The role also develops documentation, training materials, reporting, dashboards, analyses, and communications.

The position follows a flexible hybrid work model requiring certain onsite workdays for the Puerto Rico location. Availability for a specified time zone or schedule may be needed to meet business needs. On-call availability, including evenings, weekends, and holidays, may be required when operational demands call for it.

Requirements

• Bachelor’s or Master’s degree; equivalent relevant work experience may be considered in lieu of a degree.
• At least 6 years of experience in Medicare Part D, pharmacy benefit management, RDS, or related healthcare operations.
• Strong knowledge of Medicare Part D and the Retiree Drug Subsidy program, including eligibility, Qualified Covered Retirees, prescription drug cost reporting, CMS submissions, and financial reconciliation.
• Ability to lead, drive, and organize complex cross-functional team projects and initiatives.
• Demonstrated strategic thinking and planning skills.
• Ability to identify challenges, develop potential solutions, and lead others in implementing changes.
• Strong organizational skills and adaptability in a fast-paced environment.
• Excellent, concise, and professional presentation skills.
• Ability to clearly communicate arguments, explanations, and business requirements to technical and non-technical audiences.
• Excellent oral and written communication skills.
• Availability to work in a specified time zone or schedule to accommodate business needs.
• May need availability for on-call hours, including evenings, weekends, and holidays, depending on operational demands.
• Ability to access and navigate each department at the organization’s facilities.
• Ability to perform sedentary work that primarily involves sitting and standing.

Nice To Haves

• Bilingual fluency in English and Spanish.

Responsibilities

• Serve as a government programs process and guidance expert, primarily focused on RDS, and provide strategic and operational guidance to internal teams, clients, vendors, and other stakeholders.
• Own and oversee end-to-end administration of RDS services, including retiree eligibility, Qualified Covered Retiree management, cost reporting, reconciliation, and CMS submissions.
• Drive compliant operational implementation of initiatives in collaboration with clients, vendor partners, and internal teams.
• Engage with clients, vendors, CMS, or auditors as a subject matter expert and strategic consultant.
• Assess regulatory guidance and technical specifications and develop or guide processes and requirements for accurate, timely program administration and CMS reporting.
• Develop strategic workplans and coordinate cross-functional activities for implementation and ongoing performance of Medicare Part D initiatives.
• Develop and monitor key performance indicators, controls, and oversight programs to ensure client and CMS requirements are met.
• Analyze deviations from expected results, identify root causes and potential impacts, and coordinate corrective actions.
• Participate in and facilitate discussions about regulatory, operational, and system requirements and changes affecting RDS and other assigned government programs.
• Identify and define enhancements to government program processes and system logic and act as the business lead or representative across cross-functional teams.
• Identify, quantify, and communicate regulatory, operational, financial, and client risks and support appropriate corrective actions.
• Prepare and maintain process documentation and develop training and educational materials for internal and external audiences.
• Identify opportunities to automate, simplify, and strengthen program processes to reduce manual work and improve data quality, submission accuracy, financial integrity, and operational efficiency.
• Work with clients and leadership to develop and deliver dashboards, program reporting, and other communications.
• Support CMS, client, internal, and external audits and corrective action plans, including evidence collection, data validation, inquiry responses, remediation, and ongoing monitoring.
• Prepare ad hoc analyses and materials, including RFP responses, presentations, regulatory impact assessments, and other reporting.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager