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Form of workGuided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include:
Job Description Summary:
Under general direction, manages day-to-day monitoring and oversight of Medicare Part D activities. Interacts with and monitors delegated partners to support the effective operations of the MA-PD/Part D plan(s). Coordinates with Compliance for oversight.
Job Description
Minimum Qualifications
Preferred Qualifications
- Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
- Annual incentive bonus plan based on company achievement of goals
- Time away from work including paid holidays, paid time off and volunteer time off
- Professional development courses, mentorship opportunities, and tuition reimbursement program
- Paid parental leave and adoption leave with adoption financial assistance
- Employee discount program
Job Description Summary:
Under general direction, manages day-to-day monitoring and oversight of Medicare Part D activities. Interacts with and monitors delegated partners to support the effective operations of the MA-PD/Part D plan(s). Coordinates with Compliance for oversight.
Job Description
- Works with Pharmacy Benefit Manager and vendor partners on operational and oversight functions of a Medicare Advantage Part D plan. Coordinates with Compliance department on Part D oversight.
- Performs ongoing monitoring functions (daily, weekly and monthly) of Part D internal and delegated activities to meet compliance requirements and identify risks, remediate issues. Tracks and report results. Includes, but not limited to: appeals, grievances and MTM activities.
- Act as a liaison to address operational Part D issues including documenting issue, identifying owner, routing issue, gathering impact, and corrective action steps.
- Reviews Part D reporting prior to submission
- Completes and assists with Part D pharmacy benefit configuration, quality review and testing of Part D Benefits Benefit Configuration in conjunction with Pharmacy Operations and other internal/external staff
- Completes posting, updating and monitoring of all Part D member and provider documentation available for print or on website(s)
- Coordinates with Stars team on Part D Star metrics
- Maintains knowledge of applicable current and proposed laws, regulations, and sub-regulatory guidance (e.g., CMS, IRS, DOL, States) applicable to Part D specifically and general knowledge of Medicare Advantage requirements
- Drafts and maintains policies and procedures, standard operating procedures, and work instructions
Minimum Qualifications
- Bachelor's degree from a college or university in business, health care administration, or related academic field; or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job.
- 3 years of relevant experience with a Medicare Advantage Part D health plan administrator or pharmacy benefit manager.
Preferred Qualifications
- Experience with Kansas City market, providers, competitive and regulatory context.
- Experience with Pharmacy Benefit Manager
