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Medicare Operations Manager Jobs in Washington (NOW HIRING)

W3Global Inc.

Chief Resident Services Officer

Manassas, VA · On-site

$200K - $225K/yr

... management and the Board of Directors on Nursing and operational matters, maintaining the ... Medicare fraud and abuse issues. 14 Develops and implements the Ethics and Quality Assurance and ...

HiredFirst

DIRECTOR OF REHABILITATION (DOR)

Waldorf, MD · On-site

$72K - $93K/yr

Lead SNF rehab department operations and staff * Ensure Medicare/PDPM and regulatory compliance * Manage therapy scheduling, caseloads, and productivity * Coordinate interdisciplinary resident care ...

HEALTHSPERIEN, LLC

Policy Director

Washington, DC · On-site

$101K - $150K/yr

... management. They will have a deep expertise in Medicare Part A and B policy-related issues ... operations. * Serve as a subject matter expert in aspects of Medicare and Medicaid policy ...

TechSur Solutions

Technical Program Manager - HHS

Reston, VA · On-site

$134K - $173K/yr

... Medicare & Medicaid Services (CMS), National Institutes of Health (NIH), or Centers for Disease ... Translate agency mission and operational requirements into actionable technical strategies and ...

TechSur Solutions

Technical Program Manager - HHS

Reston, VA · On-site

$134K - $173K/yr

... Medicare & Medicaid Services (CMS), National Institutes of Health (NIH), or Centers for Disease ... Translate agency mission and operational requirements into actionable technical strategies and ...

Elevance Health

Director Pharmacy Operations

Hanover, MD · On-site

$128K - $169K/yr

Director Pharmacy Operations Director Pharmacy Operations Location: This role requires associates ... Medicare experience preferred. * Medication Therapy Management (MTM) experience preferred.

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Medicare Operations Manager information

What is a Medicare Operations Manager?

Medicare Operations Managers are professionals responsible for overseeing the daily operations of Medicare-related services within healthcare organizations or insurance companies. They ensure compliance with federal regulations, manage teams that process Medicare claims, and work to optimize workflows and efficiency. Their role also involves monitoring performance, implementing policy changes, and coordinating with other departments to ensure high-quality service for Medicare beneficiaries. These managers play a critical role in maintaining regulatory standards and improving overall operational effectiveness.

What are the key skills and qualifications needed to thrive as a Medicare Operations Manager?

To thrive as a Medicare Operations Manager, you need expertise in healthcare administration, Medicare regulations, and process optimization, typically supported by a bachelor's degree in healthcare or business administration. Familiarity with CMS guidelines, claims processing systems, and compliance management tools is essential. Strong leadership, analytical thinking, and effective communication distinguish top performers in this role. These skills are crucial for ensuring regulatory compliance, operational efficiency, and high-quality service in the management of Medicare programs.

What are some of the main challenges faced by a Medicare Operations Manager, and how can they be addressed?

A Medicare Operations Manager often encounters challenges such as staying current with frequently changing CMS regulations, ensuring data accuracy, and coordinating across multiple departments to maintain compliance and operational efficiency. Addressing these challenges involves maintaining robust communication channels, investing in ongoing staff training, and leveraging technology to automate reporting and auditing processes. Building strong relationships with compliance, IT, and customer service teams also helps streamline workflows and foster a proactive approach to problem-solving.

What is the difference between Medicare Operations Manager vs Medicare Claims Supervisor?

AspectMedicare Operations ManagerMedicare Claims Supervisor
Required CredentialsBachelor's degree in healthcare administration or related field; certifications like CPC or CMS certificationsHigh school diploma or associate's; certifications like CPC or claims-specific training
Work EnvironmentOversees multiple departments, manages staff, and ensures compliance in healthcare organizationsSupervises claims processing teams, reviews claims, and ensures accuracy in claims submission
Employer & Industry UsageHealth insurance companies, Medicare administrative contractors, healthcare providersHealth insurance companies, Medicare contractors, claims processing centers

The Medicare Operations Manager focuses on overseeing overall Medicare operations, including compliance and staff management, while the Medicare Claims Supervisor concentrates on managing claims processing and accuracy. Both roles require knowledge of Medicare policies and certifications like CPC, but differ in scope and responsibilities.

What are popular job titles related to Medicare Operations Manager jobs in Washington?

For Medicare Operations Manager jobs in Washington, the most frequently searched job titles are:

What job categories do people searching Medicare Operations Manager jobs in Washington look for?

The top searched job categories for Medicare Operations Manager jobs in Washington are:

What cities in Washington are hiring for Medicare Operations Manager jobs?

Cities in Washington with the most Medicare Operations Manager job openings:

Medicare Operations Manager jobs near you
Infographic showing various Medicare Operations Manager job openings in Washington as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 15% Part Time, 1% Temporary, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution.

Registered Manager Local Specialty

Walgreens

Odenton, MD • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Walgreens rating

5.5

Company rating: 5.5 out of 10

Based on 2,206 frontline employees who took The Breakroom Quiz

99th of 113 rated pharmacies

Job description

Responsible for directing the operation of a Walgreens Local Specialty Pharmacy, and accountable for improving unit sales, profits, and image through the overall development and protection of store assets, the selection, training, and development of personnel, and proper service to patients. Responsible for building relationships, overseeing the clinical management of patients, and growing the business at the site. Performs all duties of the Pharmacy Manager in their absence.
 
  • Models and shares customer service best practices with all team members to deliver a distinctive and joyful patient experience, including interpersonal habits that show care (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., demonstrating curiosity to identify needs and proactively helping, servicing until satisfied, championing empathy and inclusivity, etc.).
  • Responds to patient inquiries and complaints in a timely manner and answers questions to ensure a positive patient experience.
  • Connect with patients by responding to special needs and proactively offering services.
  • Patient/Clinical Management
  • Collaborates with providers to determine appropriateness of therapy. Educates patients with empathy on effective medication administration and expectations, side effect mitigation, and the importance of adherence. Regularly follows up with patients during the time of refills.
  • Enrolls and follows patients through clinical management programs.
  • Oversees the enrollment of patients with assistance programs, such as Chronic Disease Fund, confirming patient eligibility and all required reporting and documentation.
  • Responsible for ensuring compliance of team members regarding the documentation of patient management in the appropriate systems.
  • Fully abides to all compliance policies inclusive of participating in the billing and submission of claims to government- sponsored health care programs, including Medicare, Medicaid, and all other third-party payers, as well as the facilitating of prior authorizations on behalf of prescribers.
  • Works with the Pharmacy Manager toward the success of the pharmacy operation (scheduling, customer service, and in stock) and maintains a working knowledge of the pharmacy function.
  • Directs the operation of the store (front-end and pharmacy departments).
  • Improves prescription numbers, pharmacy sales, profit, and image through the accurate filling of prescriptions, and by providing courteous and efficient service to patients, prescribers, pharmaceutical manufacturers, payers, and health systems.
  • Provide direction to ensure pharmacy department procedures and practices comply with federal and state regulations and guidelines. Also ensures compliance with internal regulatory bodies and contracts with payers and pharmaceutical manufacturers (BOP, DEA, Medicare, accreditation bodies, compounding, FDA, etc.).
  • Complies with all federal and state laws and regulations and Company policies governing all drugs and products; maintains required records, documentation, and reports. Ensures completion of all required reporting.
  • Assures accurate and timely reporting of inventory for limited distribution drugs (LDD) when required (daily, weekly, and monthly).
  • Recommends and implements asset protection controls and procedures to identify and minimize profit loss.
  • Improves and maintains store condition, maintenance, and appearance for the safety, health, and well-being of patients and team members, and ensures adherence to applicable government regulations and laws.
  • Controls the store's safe and ank, including electronic register readings, cash withdrawals, cash accounts, daily cash reports, cash over and short records, and other reports related to cash management.
  • Assures proper operation and maintenance of pharmacy department systems and equipment.
  • Maintains awareness of third-party pharmacy business opportunities and assures proper administration and implementation of third-party pharmacy systems and procedures to lessen payment rejections. Resolves third-party rejection problems promptly and resubmits rejected claims for payment promptly.
  • Manages and attains inventory budgets to include selecting and ordering new, promotional, and permanent merchandise; keeping stores in stock, and liquidating overstocked, slow-moving, and/or old store merchandise.
  • Daily Planning and Execution
  • Schedules employees so that there is adequate coverage for all areas.
  • Implements store organization through proper hiring and placement, scheduling of work, assignment of responsibility, and delegation of authority.
  • Coordinates and organizes pharmacy department daily schedule of activities.
  • Prepares, submits, and files various reports and records required by the Company and various government agencies.
  • Business Planning
  • Responsible for developing the business plan to grow the business at the site and within Walgreens working with the District/Region leadership. Pursues opportunities to grow Walgreens market share at the site and within Walgreens Enterprise via other business opportunities.
  • Specific to Health System Pharmacy locations: Responsible for collaborating with internal strategic account management to deepen the relationship with the health system for overall growth of business at the site and within Walgreens.
  • Maintains and improves performance of department through the building of employee morale and motivation, rewards employees, and addresses employee complaints where appropriate, and uses Constructive Discipline policies of Company to discipline, suspend, terminate, or effectively recommend the same. Utilizes Constructive Discipline policy to ensure compliance with state and federal laws by pharmacy department personnel.
  • Assures EEO compliance through equity, consistency, and fairness; prevents workplace harassment; upholds the Open-Door policy assuring no retaliation; communicates openly and honestly to employees.
  • Manages staffing by planning for and scheduling appropriate hours in adherence with budgeting guidelines. Directs and attains payroll budget and controls use of overtime.
  • In the absence of, or alongside the RXMO, supervises pharmacy department team members to assure performance of required functions and adherence to Company policies and procedures. Ensures proper licensure of all pharmacy department personnel. Confirms pharmacy department employees are trained in all required functions regarding payer and pharmaceutical contractual requirements (adverse event reporting, data and inventory reporting, clinical management). Reaffirms with all pharmacy department personnel, regularly, their obligations regarding prescription dispensing only in good faith.
  • Ensures proper licensure of all pharmacy department personnel. Confirms pharmacy department employees are trained on all required functions regarding payer and pharmaceutical contractual requirements (Adverse event reporting, data and inventory reporting, clinical management).
  • Enforces all Company policies and procedures. Upholds federal, state, and local labor and employment laws.
  • Develops team members through orientation, training, establishment of objectiv

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