Senior Manager, Medicaid Operations
About The Position
About This Role The Senior Manager, Medicaid Operations, serves as a key leader within the Medicaid Operations team, responsible for guiding critical operational, analytical, and compliance-focused activities to safeguard against revenue leakage. This role partners closely with cross-functional teams—including Legal, Government Pricing, Trade, and Reimbursement—as well as external stakeholders to identify, investigate, and resolve 340B duplicate discount issues. The Senior Manager will define and drive operational excellence to ensure full compliance with federal and state Medicaid program requirements. The ideal candidate brings strong Medicaid Rebate operations expertise, in-depth knowledge of the 340b program, and a proven ability to lead operational processes. This role requires exceptional problem‑solving skills, sound judgment, and the ability to lead teams through complex and evolving regulatory environments.
Requirements
- Bachelor’s degree required; Advanced degree (MBA, MPH, etc.) preferred.
- 5+ years of experience in Medicaid, government pricing, contract operations, 340B program management, or related pharmaceutical/healthcare fields.
- Advanced Excel skills and knowledge of ModelN or a comparable rebate operation system.
- Strong analytical skills with the ability to interpret large data sets and compile evidence, to accelerate dispute resolutions.
- Strong knowledge of Medicaid Drug Rebate Program (MDRP), 340B program regulations, HRSA guidance, and state Medicaid operations.
- Demonstrated experience leading operational teams in a matrix reporting structure.
- High attention to detail, strong organizational skills, and ability to manage multiple priorities.
- Excellent communication, influence, and problem-solving skills.
- Ability to synthesis complex information and clearly communicate to leadership stakeholders.
Responsibilities
- Lead the Medicaid team’s efforts to develop processes and controls to identify, investigate, and resolve 340B duplicate discounts.
- Leverage data to guide 340b inquiries and enhance operational controls.
- Work with internal stakeholders to develop methodologies to detect potential duplicate discounts using state-claim-level data, HRSA 340B registry, and claims validation tools.
- Partner with external stakeholders, including state Medicaid agencies, 340B covered entities, and third‑party administrators, to determine the validity of disputes and ensure compliant resolution.
- Serve as the subject matter expert on duplicate discount regulations, HRSA guidance, and industry best practices.
- Review Quarterly Medicaid and State Supplemental Rebate invoices to confirm accuracy, timeliness, and compliance with contract terms.
- Drive process optimization initiatives to increase accuracy, efficiency, and transparency in Medicaid contract operations.
- Support audits, internal reviews, and compliance assessments related to Medicaid and 340B programs.
- Monitor emerging federal and state policy changes that impact Medicaid operations and guide the team in proactive adaptation.
- Maintain dashboards, analytical tools, and reports that provide insights into Medicaid and 340B trends, risks, and operational performance.
Benefits
- Medical, Dental, Vision, & Life insurances
- Fitness & Wellness programs including a fitness reimbursement
- Short- and Long-Term Disability insurance
- A minimum of 15 days of paid vacation and an additional end-of-year shutdown time off (Dec 26-Dec 31)
- Up to 12 company paid holidays + 3 paid days off for Personal Significance
- 80 hours of sick time per calendar year
- Paid Maternity and Parental Leave benefit
- 401(k) program participation with company matched contributions
- Employee stock purchase plan
- Tuition reimbursement of up to $10,000 per calendar year
- Employee Resource Groups participation
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What This Job Offers
Job Type
Full-time
Career Level
Manager
