Government Programs Operations Manager

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

About Capital Rx

Capital Rx is a next generation pharmacy benefits manager, overseeing prescription benefit plans on behalf of employers, unions, and government entities. Determined to transform an outdated model, Capital Rx’s mission is to change the way prescription benefits are priced and administered in the US, unlocking enduring social change. Through our platform approach, Capital Rx delivers data-driven insights and actionable strategies that reduce costs, while improving patient outcomes. Our commitment to innovation, technology and service is the reason why Capital Rx is among the fastest-growing PBMs in the country.

Position Responsibilities:

• Identifies opportunities for improvement and participates in the development of new solutions/capabilities in support of government program compliance and audit readiness
• Collaborate with Compliance to oversee timely implementation of regulatory & sub-regulatory guidance, coordinating tasks & workplans across impacted operational departments
• Manage error handling and change management for PDE/Encounters, plan finder, etc.
• Monitor internal government programs operations and resolve any identified operational errors, including root cause analysis and the development and implementation of necessary actions
• Support claims correction for retro-eligibility changes and COB
• Support audits of government programs (government, client or internal)
• Documents policies and procedures, reporting and project specifications, job aids and workflows within the department
• Leverage deep understanding of Medicare & Medicaid market, regulatory environment to support product strategy and service delivery
• Maintain current knowledge of Medicare & Medicaid requirements to facilitate compliance of ongoing business operations
• Foster a high-performance culture through mentoring collaboration. Provide team members with constant and consistent performance feedback/direction. Assess impact of new business to understand scalability and staffing needs

Required Qualifications:

• 6+ years of relevant PBM and/or Health Plan experience supporting Medicare Part D
• Thorough knowledge Medicare regulatory requirements and associated product and/or operational workflows
• MS Excel Skills – ability to create/maintain pivot table, forms, and formula’s (i.e. vlookup, true, if, left, etc)
• Ability to balance multiple complex projects simultaneously
• Extremely flexible, highly organized, and able to shift priorities easily
• Attention to detail & commitment to delivering high quality work product
• Excellent written and verbal communication skills

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.