Medicare Part D Product Lead — Regulatory & Compliance

Navitus; Madison (WI); On-site; USD 95,000 - 135,000; Full time

Benefits offered by this job

Top health, dental and vision benefits

20 days paid time off

4 weeks parental leave

9 paid holidays

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan and Pro/M-

Referral Bonus Program - up to $750!

Job summary

Navitus Health Solutions is seeking a Product Manager to lead Medicare Part D design, implementation, and oversight. The PM will ensure regulatory compliance with CMS guidance and oversee processes that support Part D clients and Navitus as a whole.

The role requires deep Part D expertise, strong project management, and collaboration with Compliance and Sales teams to address audits, guidance interpretation, and client needs.

Qualifications

• Bachelor’s degree or equivalent work experience in Medicare Part D required.
• 3 years of Medicare Part D experience required.
• Expertise in Medicare Part D regulations and demonstrated accountabilities in areas such as coverage determinations, appeals and grievances, prior authorizations, formulary management, transition monitoring, etc. is preferred.
• Experience in government program compliance oversight and CMS audit protocol highly desired
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

Responsibilities

• Develops and maintains deep subject matter expertise related to Medicare Part D rules and regulations.
• Monitors and interprets CMS regulations, guidance, and system changes. Ensures the Medicare Part D function meets all regulatory requirements.
• Manages the development, implementation, and maintenance of Medicare Part D processes for all Medicare Part D clients. Develops the necessary project plans and leads projects that enhance the Medicare Part D program. Implements requirements utilizing project management tools/principles. Ensures process is stable and effective monitoring mechanisms are established.
• Performs operational oversight for services delegated to Navitus by Medicare D clients. Aligns oversight mechanisms with identified risks.
• Identifies/implements process improvements to gain efficiencies, improve automation and/or mitigate non-compliance/risk. Ensures process is scalable for future growth. Strives for “best practice” where possible.
• Actively participates in implementing corrective action to address compliance issues. Ensures the actions are correcting the root cause, preventing future reoccurrence and that appropriate detection/monitoring mechanisms are in place. Engages Medicare Compliance leadership with all non-compliance related issues and/or when obstacles arise. Supports compliance efforts including CMS audits and client oversight audits.
• Provides SME support to the organization and to Navitus’ Med D clients related to guidance interpretation; operational processes that support the Med D requirements; problem solving of issues/questions; and implementation/reimplementation support.
• Supports Sales efforts with Request for Proposal (RFP) responses specific to Medicare Part D, as needed.
• Ensures that policies and procedures exist to document that Navitus complies with all Part D/regulatory requirements. Performs oversight to ensure guidance citations are accurate and current. Conducts periodic audits to ensure the functional areas are performing duties consistent with the documented policy.
• Other duties as assigned

Skills

Medicare Part D knowledge

Regulatory compliance

CMS audit experience

Project management

Stakeholder communication

Education

Bachelor’s degree in related field

Job description

Navitus Health Solutions is seeking a Product Manager to lead Medicare Part D design, implementation, and oversight. The PM will ensure regulatory compliance with CMS guidance and oversee processes that support Part D clients and Navitus as a whole.

The role requires deep Part D expertise, strong project management, and collaboration with Compliance and Sales teams to address audits, guidance interpretation, and client needs.