The Medicaid Product Manager (PM)
will be responsible for providing product management for the Navitus Medicaid program. The Product Manager (PM) will lead efforts to design, develop, and implement various Medicaid software and associated process changes according to requirements defined by the Centers for Medicare and Medicaid Services (CMS) and each State regulating entity. The PM is responsible for reviewing and acting upon all CMS and State guidance related to these functions, including technical guidance as well as business process-related guidance. The PM ensures that the appropriate software, processes, and procedures are implemented to meet these requirements. The PM must work closely with all key functional areas that administer the Medicaid function. The PM may also administer certain Medicaid functions. The PM provides support to the Sales, Clinical and Client Services departments.
This role requires both experience in project/product management, technical writing skills; as well as deep knowledge of Medicaid rules, regulations and compliance.
• Develops and maintains deep subject matter expertise related to CMS and State Medicaid requirements for provider materials, formulary / PDL, coverage determinations, grievances and appeals, FWA, customer care and pharmacy helpdesk, MIS / IT, third party liability, 340B, rebates, and reporting.
• Manages the development, implementation, and maintenance of Medicaid software processes for all Managed Medicaid clients. Develops the necessary project plans and leads projects that enhance the Medicaid infrastructure.
• Participates in state sponsored meetings as requested and disseminates information throughout Navitus.
• Monitors and interprets CMS and State regulations, guidance, and system changes. Ensures the Medicaid functions meet all regulatory requirements.
• Responsible for operational oversight of the Navitus Managed Medicaid product line. Provides direct functional support for required reporting and provider/member materials. Provides support for other Navitus departments as needed. Coordinates all operational and compliance related items with Managed Medicaid business partner.
• Provides product support for client implementations and re-implementations. Provides SME support to Navitus Client and Clinical Services Executives representing the client.
• Provides oversight for issue resolution. Engages the Program Manager with all non-compliance related issues and/or when obstacles arise. Drafts and leads the execution of performance improvement plans or corrective action plans to address. Leads compliance efforts including State, CMS audits and client delegation audits.
• Supports Sales force with RFP responses specific to Medicaid operational responses. May participate in finalist presentations.
• Contributes to strategy, goal setting and policy administration plans for the Medicaid function. Develops and maintains product documentation, including training materials. Develops, modifies, and improves business processes and policies through P&P’s.
• Assists the Program Manager in reviewing and managing updates to State contracts, ensuring content is in line with agreed upon services and regulations.
• Accountable for ensuring that policies and procedures (internal controls) are in place to provide reasonable assurance that the company assets are protected.1The Product Manager may have direct responsibility for a subset of the above responsibilities due to the scope and breadth of Medicaid product offerings.