Medicaid Program Manager Jobs in Silver Spring, MD

Resp & Qualifications

PURPOSE: 
Manages end-to-end oversight of Pharmacy initiatives.  Drives teams and internal projects to maintain and enhance program performance over time. Guides stakeholders through key decisions, communicates and coordinates activities internally and across departments. Facilitates process improvement and identifies and articulates stakeholder needs to drive pharmacy strategies and maximize outcomes related to ROI, customer satisfaction, and organizational metrics and performance.
ESSENTIAL FUNCTIONS:

• Manages complex pharmacy program(s) or strategic initiatives that span organizational boundaries and have a significant legal and/or financial impact to CareFirst Business. Identifies process improvement opportunities and takes action to implement enhancements to maximize outcomes and growth. 

• Coordinates with internal and external stakeholders to launch, maintain, and enhance complex pharmacy program(s). Provides direction and motivation to project teams in a matrixed environment.  Drives outcomes by fostering a collaborative culture. Manages relationships with key stakeholders, including management and vendors. Develops and provides formal written and verbal presentations or other communication materials for appropriate management and various committees to support Pharmacy programs and initiatives. Leads innovative solutions to meet pharmacy and corporate goals.  

• Monitors PBM compliance, financial performance and reconciliations while identifying trends to support strategic decision-making. 

• Oversees a key initiative focused on the timely and accurate calculation of payments and reconciliations for pharmacy rebates, network discounts and medicate rebates for ASO/CFA accounts. 

• Measures, evaluates and reports on Pharmacy program(s) performance related to ROI, customer satisfaction, and other organizational metrics. Effectively forecasts and manages people, process and technology related resources to ensure successful achievement of corporate goals.

• Guides stakeholders and leadership through key decisions and communicates and coordinates activities internally and across network of partners.

SUPERVISORY RESPONSIBILTY: 

Leads a team utilizing a matrix management system. 
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business Management or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 8 years project management or program management experience.

Licenses/Certifications:
Certified Project Management Professional (PMP)-PMI   Preferred
Preferred Qualifications:

• Master's Degree
• Project Management Professional Certification (PMP) 
• 8 years of Progressive experience in pharmacy wthin one or more of the following areas: PBM, healthcare finance or analytics. 

Knowledge, Skills and Abilities (KSAs)

• Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions. 
• Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.  
• Ability to translate business needs as it relates to technology, systems, and vendor platforms.
• Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
• Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.
• Knowledge and discipline of Process Improvement.
• Use of Microsoft Applications.
• Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts. 
• Experience in Medicare, Medicaid and/or Commercial pharmacy operations. 
  

Travel Requirements
Estimate Amount: Limited

Salary Range: 106,632 - 211,783

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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