Summary
The Medicare Part D Performance Management Specialist will report to the Director of Pharmacy and will be responsible for monitoring contractual, operational, reporting, and regulatory requirements for Medicare Part D / EGWP lines of business.
Duties
- Serves as a subject matter expert to Centers for Medicare & Medicaid Services (CMS) Part D / EGWP regulatory requirements.
- Able to navigate and research CMS policies and memorandums specific to Part D / EGWP and provide guidance to the plan and vendor partners.
- Oversees and maintains the fully insured Part D / EGWP administrator contractual and regulatory functions.
- Responsible for analyzing data specific to Part D / EGWP on all lines of business.
- Monitor key performance indicators in clinical, operational, and vendor management areas to proactively inform leadership and departmental business owners of risks and issues from the administrator.
- Track critical issues and work cross-functionally with internal and external business owners focusing on the remediation activities while maintaining strong lines of communication.
- Develop and monitor corrective action plans for areas that are not meeting contractual and regulatory requirements.
- Work in conjunction with the Vice President and Director of Pharmacy to align Medicare Part D / EGWP lines of business to organizational goals and initiatives.
- Performs other related duties and projects as assigned.
Education Requirements
Bachelor’s Degree or equivalent experience
Experience Requirements
- 3 or more years of managed care experience, specifically in relation to pharmacy benefits.
- 2 or more years of experience in Medicare Part D / EGWP.
- Knowledge of Medicare Part D STARs measures.
- Experience with computer-based data processing including Microsoft Office products, and database application.
- Information analysis for problem-solving and solution development.
- Strong verbal and written communication skills.
- Experience with prioritizing the demands of multiple tasks while meeting essential deadlines.
- Proven self-starter with the ability to lead multiple projects in a fast-paced, changing environment.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. We celebrate diversity and are committed to creating an inclusive environment for all employees.
