Government Programs Manager
About The Position
The Government Programs Manager serves as an internal subject matter expert for government-driven programs, with a primary focus on the Retiree Drug Subsidy (RDS). The role oversees accurate, timely, and compliant administration of RDS services for clients and stays current on CMS guidance, technical specifications, submission requirements, and program changes. The manager translates regulatory requirements into business processes, system requirements, operational controls, and monitoring programs. The position connects claims, eligibility, financial data, technology, operations, clients, and CMS requirements to support complete and timely program execution. It develops and monitors program controls and performance measures, supports implementation and ongoing performance of Medicare Part D initiatives, and works across the organization and with clients to address challenges. The role may also support other assigned government programs.
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 projects and initiatives, with demonstrated strategic thinking and planning.
- Creative and curious approach to identifying challenges, developing potential solutions, and leading implementation of changes.
- Highly organized and adaptable, with the ability to work in a fast-paced environment.
- Excellent, concise, and professional presentation skills.
- Ability to clearly articulate 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 the business needs of clients and team members.
- May need to be available for on-call hours, including evenings, weekends, and holidays, to address emergent issues or provide support when operationally required.
- Must be able to access and navigate each department at the organization’s facilities.
- Sedentary work that primarily involves sitting or standing.
Nice To Haves
- Bilingual fluency in English and Spanish.
Responsibilities
- Serve as a government programs process and guidance expert, primarily focused on RDS, providing strategic and operational guidance to internal teams, clients, vendors, and stakeholders.
- Own and oversee end-to-end 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, and auditors as a subject matter expert and strategic consultant.
- Assess regulatory guidance and technical specifications and build 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 requirements for regulatory, operational, and system changes affecting RDS and other assigned government programs.
- Identify and define enhancements to government program processes and system logic, and serve as the business lead or representative across cross-functional teams.
- Identify, quantify, and communicate regulatory, operational, financial, and client risks, and support 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 intervention 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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
