Program Manager, Medicaid Cert and Compliance

Navitus Health Solutions; Appleton (WI); Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare services firm in Appleton, WI is seeking a Medicaid Cert and Compliance Program Manager to manage CMS certification activities. The role involves operational management, project planning, and regulatory compliance oversight. Ideal candidates will have a Bachelor's degree, multiple years of relevant experience, and experience in leading certification or accreditation projects. The position offers top-tier benefits and a potential for remote work.

Benefits

Top industry benefits for Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

9 paid holidays

401K with company match

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Referral Bonus Program

Qualifications

• 3 years of experience managing operational teams and conducting certification exercises.
• 5 years of Program/Product and/or operational management experience.
• Experience in certification or accreditation projects required.

Responsibilities

• Manage all activities related to CMS certification.
• Conduct readiness assessments and gap analyses.
• Oversee policy and procedure administration.

Education

Bachelor's degree

MBA, MHA, MPA or advanced business degree

Tools

PMP certification

CSM certification

Job description

Overview

Navitus Health Solutions is seeking a Medicaid Cert and Compliance Program Manager to join our team!

The Program Manager, Medicaid Cert and Compliance requires regular interfacing and communicating with external clients and constituents regarding FFS pharmacy claims-processing, operating performance measures and technical development that all support the regulatory contracted needs of States and the fiscal commitments to the Company by the business unit. This role may serve, at times, as a point of contact for contracted clients and all other constituents. The Program Manager collaborates with the Implementation Manager regularly and extensively to ensure that the FFS products and services scheduled or contracted for delivery are on schedule and fulfilling committed business functions. This partnership is key for successful delivery of new services to the marketplace, ensuring state certification readiness, and product road map alignment with market needs.

The Program Manager, Medicaid Cert and Compliance is supported by the FFS Implementation Manager to plan, schedule and monitor all activities leading to successful CMS certification on behalf of our clients. The Program Manager develops project plans and operation performance metrics that drive teams to successful CMS certification. Lastly, the Program Manager role is a critical operating connection for technical resources, FFS functional subject matter experts, government market-sensitivity, proposal development and financial performance; previous direct experience in several of these capacities is key.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Manage, plan, direct, advise and oversee all activities related to CMS certification.
• Support, and when directed, lead FFS day-to-day operational activities.
• Develop and manage certification project plans, timelines and deliverables.
• Continually monitor accepted FFS' CMS certification and program performance indicators that ensure established goals and deadlines are met.
• Serve as the primary point of contact with CMS, auditors and other regulatory agencies.
• Conduct readiness assessments, gap analyses and mock audits to ensure successful certification outcomes.
• Support the creation and presentation of data for strategic business planning, including development of new business initiatives, budgets, resource demands, and operating execution.
• Identify and present opportunities to improve P&L, team culture and FFS growth.
• Provide leadership, training and guidance to cross-functional teams involved in certification activities.
• When applicable, facilitate the hiring process, on-boarding process, mentoring and termination process for client/account team members as well as Business Analysts assigned to expanding functional requirements in the market.
• Maintain up to date knowledge of CMS rules, regulations, and changes in certification requirements.
• Support continuous improvement initiatives to strengthen compliance and reduce certification risks.
• Support, develop and participate in procurement efforts for new business opportunities.
• Oversee policy and procedure administration; ensure regulatory and contractual compliance including individual contract service-level agreements.
• Travel as necessary to support marketing and delivery needs of FFS commitments.
• Other duties as assigned.

Qualifications

What our team expects from you?

• Bachelor's degree required. MBA, MHA, MPA or advanced business degree preferred.
• PMP & CSM certifications preferred.
• 3 years of experience required in managing operational teams, conducting certification exercises using complete CMS' MECT criteria or selected case reviews, and developing cost proposals.
• 5 years of Program/Product and/or operational management experience in the pharmacy benefit delivery market required, preference to candidates with state Medicaid program experience.
• Experience in leading certification or accreditation projects (e.g. CMS, NCQA, URAC, or Joint Commission) required.
• Knowledge of CMS regulations, certification processes, and healthcare compliance standards required.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

#LI-Remote

Location

Address: 1025 West Navitus Dr., Appleton, WI 54913, US