United States onlyPutting People First in Pharmacy- 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. 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 unable to offer remote work to residents of Alaska, Hawaii, Maine, Mississippi, New Hampshire, New Mexico, North Dakota, Rhode Island, South Carolina, South Dakota, West Virginia, and Wyoming.
The Medicaid Product Manager (MPM) will be responsible for providing regulatory support for the Navitus Medicaid program. The Product Manager (MPM) will facilitate efforts to develop and implement various Medicaid process changes according to the requirements defined by the Center for Medicare and Medicaid Services (CMS) and each State regulating entity. The MPM is responsible for reviewing and acting upon all CMS and State guidance related to these functions, including technical guidance as well as business process-related guidance. The MPM must work closely with all key functional areas that administer certain Medicaid functions, including but not limited to Implementation, Formulary Administration, Provider Services, Clinical and Client Services departments.
Is this you? Find out more below!
How do I make an impact on my team?
- 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
- Develops the necessary project plans and lead projects that enhance the Medicaid operational infrastructure
- Participates in state sponsored meetings as requested and disseminates information throughout Navitus
- Monitors CMS and State regulations, guidance, and system changes
- Ensures the Medicaid functions meet all regulatory requirements. Responsible for operational oversight of the Navitus Managed Medicaid product line
- Provides subject matter expert support to Navitus Client and Clinical Services Executives representing the client
- Assists with engaging the Program Manger with all non-compliance related issues and/or when obstacles arise
- Supports compliance efforts including State, CMS audits and client delegation audits
- Supports the development of maintenance of product documentation, including training materials
- Assists the Program Manager in reviewing and managing updates to State contracts, ensuring content is in line with agreed upon services and regulations
What our team expects from you?
- 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/relationship-building/management in health care or related environment is essential
- 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 a plus.
- Participate in, adhere to, and support compliance program objectives
- The ability to consistently interact cooperatively and respectfully with other employees
What can you expect from Navitus?
- Hours/Location: Monday-Friday 8:00am-5:00pm CST, Appleton WI Office, Austin TX Office or Remote
- Paid Volunteer Hours
- Educational Assistance Plan and Professional Membership assistance
- Referral Bonus Program – up to $750!
- Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Nine paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program
