[Remote] Program Manager, Medicare Part D Implementation at Devoted Health

United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

3 years plus experience in pharmacy operations at a health plan or pharmacy benefit manager (PBM)
Strong initiative and ability to process improve
Data analysis and strong Excel/Sheets experience
Strong understanding of CMS Guidance and HPMS (Health Plan Management System) Memo guidance updates

Responsibilities

Complete oversight of all implemented CMS Part D Program functions delegated to the PBM
Collaborate with internal stakeholders for annual new and existing plan implementation as well as CMS Part D Program functions
Coordinates with Compliance department on Part D oversight
Act as a liaison to address operational Part D issues including documenting issues, identifying owner, routing issue, gathering impact, and corrective action steps
Devoted Health Part D subject matter expert to assist internal and external partners to resolve any questions or concerns around Part D benefits and pharmacy claim adjudication through implementation and welcome season
Maintains knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e.g., CMS, HPMS memos) applicable to Part D specifically and general knowledge of Medicare Advantage requirements
Drafts and maintains policies and procedures, standard operating procedures, and work instructions for implementation projects

Skills

Key technologies and capabilities for this role

CMS Part DPharmacy OperationsPBMHPMS MemosExcelGoogle SheetsData AnalysisProcess ImprovementMedicare AdvantageCompliance

Questions & Answers

Common questions about this position

What is the salary range for the Program Manager, Medicare Part D Implementation role?

The salary range is $76,000 - $120,000 per year. The actual base salary will depend on factors like qualifications and experience, with more details provided during the interview process.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What are the required skills and experience for this role?

Required skills include 3+ years in pharmacy operations at a health plan or PBM, strong initiative and process improvement ability, data analysis with strong Excel/Sheets experience, and strong understanding of CMS Guidance and HPMS Memo updates.

What is the team structure like for this position?

The role reports directly to the Sr. Program Manager, Pharmacy, and collaborates with the Program Manager, Sr. Pharmacy Program Associate, and Pharmacy Program Associate as part of the Pharmacy Operations team.

What experience makes a candidate stand out for this role?

Candidates with experience in Medicare Part D Operations, understanding of Pharmacy Benefit Management Medicare Requirements, ability to review HPMS Memos and apply to implementations, and skills in handling PBM testing files and letter approvals will stand out.

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

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