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Medicare Part D and EGWP Program Manager
2 months ago
The selected candidate will oversee the operational activities of Medicare Part D and EGWP programs, ensuring compliance with CMS rules and regulations. This role requires a strong understanding of benefit designs, system management, and quality control.
Key Responsibilities- Provide oversight of operational activities of Medicare Part D/EGWP programs
- Ensure compliance with CMS rules and regulations surrounding Medicare Part D
- Support vendor relationships, daily operations, and implementation of EGWP pharmacy programs
- Understand service agreements and terms between ProAct and vendor partners and clients
- Act as primary point of contact for Plan Sponsor contracted to administer programs
- Understand benefit build, eligibility, enrollment, formulary, claims processing, clinical, files management, reporting, and other components of EGWP programs
- Coordinate with implementation teams to ensure accurate benefit build and claims processing
- Responsible for supporting inquiry/issue/escalation resolution
- Oversee resolution of prescription drug event (PDE), eligibility, or other issues that are necessary for EGWP programs
- Maintain understanding and compliance with current on rules and regulations pertaining to Medicare Part D/EGWP programs
- Evaluate potential impact and applicability of new or changed rules and/or regulations
- Identify performance and compliance risks and communicates to leadership and/or others in a timely manner to minimize non-compliance
- Review new guidance, memos, and regulations and create and adjust internal policies, processes, and/or procedures appropriately. Communicate changes to leadership and/or others as required.
- Supports collaborative relationships with internal and external teams or partners to determine best practices, efficiencies, or process improvements that enhance program performance and member experience.
- Partner with other departments or business units to grow, develop, and enhance EGWP programs and opportunities
- Assist in creation of member and client materials ensuring consistent with CMS regulations
- Support client service teams with presenting analytics or other reports to clients and/or business partners
- Excellent oral and written communication skills
- Ability to create and conduct effective presentations
- Problem solving and analytical skills
- Strategic and creative thinker
- Strong organizational skills
- Self-motivated with ability to prioritize multiple tasks along with a strong sense of urgency and responsiveness
- Proficient in Microsoft Office and Adobe
- Understanding of PBM and/or TPA industry, preferred
- Minimum: High School Diploma (or currently enrolled) or GED
- Preferred: BS Degree in Business or similar
- 5+ years experience in Medicare Part D and/or EGWP programs
