Senior Manager – Government Program Operations
Capital Rx
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $120,000 - $135,000 per year
Job Level
About the role
- Lead Government Programs support for Exchange business functions including claims adjudication, regulatory reporting, and audit support (Government, and Client).
- Leads the interpretation, implementation and monitoring of all relevant regulatory requirements and changes impacting Capital Rx’s Exchange Programs.
- Establish and maintain the EDGE pharmacy submission playbook (file intent, lineage, duplicate controls, timestamp standards, enrollment alignment).
- Define and enforce submission cadences, pre‑submission QA gates, and accept/active/non‑orphan targets that meet CMS sufficiency timelines.
- Translate CMS updates into operational SOPs and training.
- Partners with cross‑functional SMEs to analyze regulatory changes, determine their implications for organizational processes, systems, and client commitments, and leads the coordinated, on‑time implementation of required updates across the enterprise.
- Manages timely response to Government Programs support for RFP/RFI, internal sales, and Exchange client requests.
- Provides key insights on Exchange functions using data analysis, industry knowledge and subject matter expertise to identify opportunities, and develop solutions, for optimization of internal business processes and systems.
- Supports the documentation management of internal policies and procedures, reporting and project specifications, job aids, and workflows for designated Government Programs Operations.
- Leverages profound knowledge of Exchange guidance and understanding of industry and market requirements to support product strategy and service delivery.
- Maintains current knowledge of Exchange requirements to facilitate compliance of ongoing business operations.
- Fosters a high-performance culture through mentoring and collaboration, providing team members with ongoing performance feedback and identifying required changes to existing roles and responsibilities to ensure effectiveness and efficiency.
- Assesses impact of new business to understand scalability and staffing needs.
Requirements
- 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange plans
- 5+ years people management experience
- Vast knowledge of Exchange regulatory requirements and associated product and/or operational workflows
- Proven success managing 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
- Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysisproject managementregulatory reportingclaims adjudicationSOP developmentQA processessubmission managementprocess optimizationdocumentation managementperformance feedback
Soft Skills
people managementflexibilityorganizational skillsattention to detailcommunication skillscollaborationmentoringrelationship managementproblem-solvingleadership