Pharmacy Part D Operations Manager MAPD PBM IPA Ops Mgmt Exp
Pharmacy Part D Operations Manager MAPD PBM IPA Ops Mgmt Exp
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Job Description
Alignment Health is breaking the mold in conventional health care committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fastgrowing company you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters not only changing lives but saving them. Together.
The Operations Manager oversees operations related to our Medicare Part D program including the Medicare Prescription Payment Plan and drive annual readiness and expansion initiatives. This individual contributor will manage daytoday operations optimize workflows and ensure compliance with CMS regulations. This role will also collaborate with internal leadership business owners PBM partners and key stakeholders to enhance pharmacy services and improve operational efficiencies.Job Duties/Responsibilities:
for oversight and management of the Medicare Prescription Payment Plan.
2. Implement various programs and initiatives to support Pharmacy department and organizational goals. Support development of project plans and optimization of operational workflows.
3. Manage Part D annual readiness and expansion activities. Collaborate with Product team on Part D application and bid submissions to CMS. Support build of pharmacy benefits in PBM system.
the development preparation and quality control of Part D member materials including the Annual Notice of Change (ANOC) Evidence of Coverage (EOC) and Summary of Benefits.
issues arising from operations and coordination with internal and external stakeholders and vendors.
cross functionally to ensure seamless operations and optimal member support.
compliance with regulatory requirements and support compliance program objectives.
process documentation policies and procedures and training materials.
with SOX documentation requirements and audit support.
10. Other duties as assigned.
Job Requirements:
Experience:
Required: A minimum of 5 years related experience in an MAPD plan PBM or IPA required
Preferred: 3 years in a operations management role
Education:
Required: Bachelors degree in a relevant field (e.g. Healthcare Administration Business Administration Pharmacy or Public Health)
Preferred: Masters degree (MBA MHA MPH)
Specialized Skills:
Required:
Ability to communicate positively professionally and effectively with others; provide leadership teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members management employees and vendors.
Attention to Detail:Ensures accuracy and compliance in all Medicare Part D documentation and processes with a strong focus on quality control and thoroughness.
Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem solving; ability to use advanced reasoning to define problems collect data establish facts draw valid conclusions and design implement and manage appropriate resolution.
Problem solving Skills: Effective problem solving organizational and time management skills and ability to work in a fast paced environment.
Project Management Skills: Ability to work cross functionally to ensure project goals are of adjusting project plans and strategies in response to changing circumstances and stakeholder needs.
Licensure:
Required: None
Other:
Required: Occasional onsite travel to the corporate office in Orange CA may be required. Candidates should be prepared to travel up to 10 of the time to meet business needs.
PAY RANGE:$90000 $100000 annually
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
performing the duties of this job the employee is regularly required to talk or hear. The employee regularly is required to stand walk sit use hand to finger handle or feel objects tools or controls; and reach with hands and arms.
employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
Pay Range: $85696.00 $128543.00Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability age protected veteran status gender identity or sexual orientation.
*DISCLAIMER:Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employmentrelated offers in exchange for money or other sensitive personal be advised that Alignment Health and its subsidiaries will never ask you for a credit card send you a check or ask you for any type of payment as part of consideration for employment with our you feel that you have been the victim of a scam such as this please report the incident to the Federal Trade Commission at If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Healths talent acquisition team please email.
Required Experience:
Manager
Employment Type
Full-Time
