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
    • 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.
221 Crescent Street, Waltham, MA 02453

What are Devoted Health Perks + Benefits

Health Insurance & Wellness Benefits
Dental Benefits
Vision Benefits
Health Insurance Benefits
Onsite Gym
Retirement & Stock Options Benefits
Company Equity
Child Care & Parental Leave Benefits
Generous Parental Leave
Flexible Work Schedule
Vacation & Time Off Benefits
Unlimited Vacation Policy
Generous PTO
Perks & Discounts
Casual Dress
Stocked Kitchen
Some Meals Provided
Parking
Fitness Subsidy
Professional Development Benefits
Job Training & Conferences
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