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Program Manager, Medicare Part D

| Waltham
A bit about us:
Devoted Health is a new health care company looking to improve the lives of seniors in America. We are guided by a deep belief that every senior should be treated like we would treat a member of our own family: with loving care and a profound commitment to their health and well-being. With aging demographics and rising health costs, this is an industry and problem space that needs today’s best talent working on solutions with high integrity and a long term view. We will improve the lives of seniors by helping them navigate the healthcare system, by utilizing world-class technology and data to enable a simplified experience, by partnering with top providers for better health outcomes. We are building a stellar team to drive towards our starting point goal to launch a Medicare Advantage plan and clinical services in 2019.
Why Devoted:
Make a difference... a big difference. You will have the opportunity, in a unique and dynamic culture, to be a part of something incredibly meaningful. We’re a disruptive startup with an inspiring mission. Learn and grow alongside our world-class team of healthcare, technology, and data leaders, dedicated to building a health plan and clinical services that care for everyone like they were our own mothers or fathers. Our team and board members have decades of experience in health care entrepreneurship, data, technology, services, and policy. With their support, we look forward to building a health plan and clinical services that will give seniors easy access to the high-quality care they deserve.
Position Summary: 
The Medicare Part D Program Manager is responsible for analyzing, planning, and performing program oversight of the Devoted Health Part D program, including our Pharmacy Benefits Manager. This role acts as the Medicare Part D and program oversight subject matter expert. The Medicare Part D Program Manager works closely with the Pharmacy Benefits Manager and vendor partners to ensure its Part D benefit is administered accurately, timely and in compliance with CMS regulations.

Role responsibility:

  • Works with Pharmacy Benefit Manager and vendor partners on Part D operational and oversight functions of Devoted Health
  • Coordinates with Compliance department on Part D oversight
  • Performs ongoing monitoring functions (daily, weekly and monthly) of Part D internal and delegated activities to meet compliance requirements and identify risks, remediate issues. Tracks and report results. Includes, but not limited to: coverage determinations, appeals, grievances,rejected/paid claims review and MTM activities
  • Act as a liaison to address operational Part D issues including documenting issues, identifying owner, routing issue, gathering impact, and corrective action steps
  • Works with Devoted vendor partners to assist with Part D oversight activities
  • Reviews Part D reporting prior to submission
  • Completes and assists with Part D pharmacy benefit configuration, quality review and testing of Part D Benefits Benefit Configuration in conjunction with Pharmacy Operations and other internal/external staff
  • Completes posting, updating and monitoring of all Part D member and provider documentation available for print or on website
  • Coordinates with Stars team on Part D Star metrics
  • Maintains knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e.g., CMS) applicable to Part D specifically and general knowledge of Medicare Advantage requirements
  • Drafts and maintains policies and procedures, standard operating procedures, and work instructions
  • Actively researches and stays current with requirements from CMS to ensure that Part D program is in compliance with government regulation. Develops and maintains a prioritized list of CMS and/or customer requirements for products

Attributes to success:

  • Ability to communicates to both internal and external clients on new developments
  • Enjoy engaging in the outlining of program development and management processes, manages the overall scoping, planning, business requirements gathering and delivery of Medicare Part D products and programs to customers from idea inception to ongoing support and enhancement
  • Communicate with internal and external stakeholders - progress reporting and vendor management
  • Facilitate sharing of expertise by training other departments in support of Part D program
  • Serves as a mentor for other team members to achieve scalability

Qualifications:

  • 5+ years of experience in Medicare Part D
  • Proven track record of growing employees and managing partners / vendors
  • Background in pharmacy claims, formulary oversight, coverage determination and appeals/grievances, customer care oversight
  • Ability to analyze Part D related (call and claims) data and using the results to effectively manage PBM
  • Bachelor’s preferred

If you love running towards complex challenges and transforming them into solutions, if you want to make a potentially huge impact on many lives, and if you are looking to build something from the ground up in a disruptive startup with an inspiring and talented team, Devoted Health may be the place for you.

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Technology we use

  • Engineering
    • GolangLanguages
    • PythonLanguages
    • TypeScriptLanguages
    • ReactLibraries
    • recomposeLibraries
    • Apollo GraphQLLibraries
    • AngularJSFrameworks
    • gRPCFrameworks
    • AWSFrameworks
    • PostgreSQLDatabases
    • RedshiftDatabases

Location

Our sunny office is in the beautiful Watch Factory alongside the Charles River in Waltham. It's easily reachable by commuter train, bus, or bike.

What are Devoted Health Perks + Benefits

Devoted Health Benefits Overview

We offer bright, open office space with plenty of flexibility, awesome colleagues and a strong focus on our mission and supporting the work/life balance of all Devotees. We believe that taking care of ourselves will help us deliver the best possible service to our members.

We offer a free(100% employer paid) HMO Plan through Blue Cross Blue shield for our employees and their families. We also offer a PPO plan at a very limited cost.

Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Dental Benefits
Fully company paid through Blue Cross Blue Shield
Vision Benefits
Fully company paid through Blue Cross Blue Shield
Health Insurance Benefits
We offer a free(100% employer paid) HMO Plan through Blue Cross Blue shield for our employees and their families. We also offer a PPO plan at a very limited cost.
Life Insurance
Offered through the Hartford
Wellness Programs
Wellness program where you can earn money back for healthy behavior along with an onsite gym and cross fit classes onsite
Onsite Gym
Yes, in our facility
Retirement & Stock Options Benefits
401(K)
Yes, we offer a 401K
Company Equity
Equity offered to all Devotees
Child Care & Parental Leave Benefits
Generous Parental Leave
We offer 3 months fully paid for maternity leave and 1 month paternity leave
Flexible Work Schedule
Family Medical Leave
Yes
Vacation & Time Off Benefits
Unlimited Vacation Policy
Generous PTO Polity
Generous PTO
Perks & Discounts
Casual Dress
We embrace the "bring your whole self to work" mantra and want folks to feel comfortable doing their best work
Company Outings
Company retreats, happy hours and team events
Stocked Kitchen
We offer healthy snacks including fresh fruit, bagels and cream cheese, popcorn, energy bars and dark chocolate.
Some Meals Provided
Free lunch weekly
Parking
Free parking onsite
Fitness Subsidies
BCBS reimburses up to 3 months of health club fees
Professional Development Benefits
Job Training & Conferences
We encourage and support our employees in continuing their educational endeavors.
Diversity Program
Devoted has a strong focus on building the most diverse and inclusive workforce we can. We won a 2018 NEVY award for diversity

Additional Perks + Benefits

The people at Devoted are drawn together with the common mission of making a material difference in the healthcare system as a whole and specifically in the lives of the members we serve. We are the type of company that supports employees as they move through the stages of their life while providing constant learning and opportunities for growth and change.

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