Program Manager, Medicaid Cert and Compliance

Navitus Health Solutions is seeking a Medicaid Cert and Compliance Program Manager to join our team!

The person has a minimum of three (5) years of successful experience managing operational teams, conducting certification exercises using complete CMS' MECT criteria or selected case reviews, and developing cost proposals. The role also requires regular interfacing and communicating with external clients and constituents regarding FFS pharmacy claims-processing, operating performance measures and technical development that all support the regulatory contracted needs of States and the fiscal commitments to the Company by the business unit. This partnership is key for successful delivery of new services to the marketplace, ensuring state certification readiness, and product road map alignment with market needs. The Program Manager is supported by the FFS Implementation Manager to plan, schedule and monitor all activities leading to successful CMS certification on behalf of our clients. The Program Manager develops project plans and operation performance metrics that drive teams to successful CMS certification. Lastly, the Program Manager role is a critical operating connection for technical resources, FFS functional subject matter experts, government market-sensitivity, proposal development and financial performance; previous direct experience in several of these capacities is key.

Is this you? Find out more below!

How do I make an impact on my team?

Manage, plan, direct, advise and oversee all activities related to certification
• Support, and when directed, lead FFS day-to-day operational activities
• Coordinate with the FFS Implementation Manager to ensure the effective coordination of all Company resources to fulfil FFS contracted commitments
• Continually monitor accepted FFS' CMS certification and program performance indicators that ensure established goals and deadlines are met
• Support the creation and presentation of data for strategic business planning, including development of new business initiatives, budgets, resource demands, and operating execution
• Support the delivery of on-going formal training to team members
• When applicable, facilitate the hiring process, on-boarding process, mentoring and termination process for client/account team members as well as Business Analysts assigned to expanding functional requirements in the market
• Oversee policy and procedure administration; ensure regulatory and contractual compliance including individual contract service-level agreements
• Other duties as assigned

What our team expects from you?

• Completed MBA, MHA, MPA or advanced business degree or comparable work experience is preferred; completed Bachelor's Degree is required
• Five (5) years of Program/Product and/or operational management experience in the pharmacy benefit delivery market is required; preference to candidates with state Medicaid program experience
• Strategic thinking ability and skills to support preparation of budgets, responses to prospective state Medicaid clients, internal project charters and business plans
• Demonstrable mentoring of staff in all aspects of research, marketing, technical and delivery related to FFS operations
• Willingness to travel as necessary to support marketing and delivery needs of FFS commitments
• Excellent verbal & written communication, presentation and negotiation skills required
• Available to participate in activities associated with states Medicaid programs
• Completed PMP & CSM certifications preferred
• 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?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

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