Medicare Part D EGWP Operations Manager

Judi Health, LLC; New York (NY); Hybrid; USD 128,000 - 160,000; Full time

Job summary

Judi Health is seeking a Government Programs EGWP Manager to drive regulatory compliance for the Health Plan EGWP line. You will oversee CMS requirements, Medicare Part D processing and audits, and coordinate across claims processing, clinical programs, and vendor relationships.

The role focuses on daily management, change management and performance metrics to meet employer, member and Health Plan objectives. Hybrid work locally to NYC, Denver, or Charlotte with salary up to $160k.

Qualifications

• Minimum of HS diploma/GED or equivalent experience.
• 5+ years of Medicare Part D and/or EGWP experience.
• Deep knowledge of Medicare Part D claim processing, CDAG oversight and CMS Part D reporting.
• Experience in a delegated and highly matrixed organization.
• Strong operational acumen.

Responsibilities

• Manage EGWP program setup, implementation and go-live readiness across functions including claims processing and clinical programs.
• Provide day-to-day management to operations analysts EGWP.
• Oversee financial performance, operational KPIs and CMS compliance metrics for PBM claims, formulary, coverage determinations, appeals and grievances.
• Lead regulatory reporting to ensure timely and accurate reporting to Health Plan, State and CMS.
• Collaborate cross-functionally across Judi Health on employer group issues and health plan oversight.

Skills

Medicare Part D knowledge

CDAG oversight

Regulatory reporting

Operational excellence

Education

HS diploma/GED

Tools

HPMS

MARx

Job description

Judi Health is seeking a Government Programs EGWP Manager to drive regulatory compliance for the Health Plan EGWP line. You will oversee CMS requirements, Medicare Part D processing and audits, and coordinate across claims processing, clinical programs, and vendor relationships.

The role focuses on daily management, change management and performance metrics to meet employer, member and Health Plan objectives. Hybrid work locally to NYC, Denver, or Charlotte with salary up to $160k.