Capital Rx · 5 hours ago
Senior Manager Government Program Operations (Exchange)
United States
Full-time
Remote
Mid, Senior Level
$120K/yr - $135K/yr
6+ years expJudi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. The Senior Manager is responsible for leading the implementation and governance of regulatory requirements for Exchange plans and overseeing compliance activities and contract applications.
Hospital & Health Care
Responsibilities
Lead Government Programs support for Exchange business functions including claims adjudication, regulatory reporting, and audit support (Government, and Client)
Leads the interpretation, implementation and monitoring of all relevant regulatory requirements and changes impacting Capital Rx’s Exchange Programs
Establish and maintain the EDGE pharmacy submission playbook (file intent, lineage, duplicate controls, timestamp standards, enrollment alignment)
Define and enforce submission cadences, pre‑submission QA gates, and accept/active/non‑orphan targets that meet CMS sufficiency timelines
Translate CMS updates into operational SOPs and training
Partners with cross‑functional SMEs to analyze regulatory changes, determine their implications for organizational processes, systems, and client commitments, and leads the coordinated, on‑time implementation of required updates across the enterprise
Manages timely response to Government Programs support for RFP/RFI, internal sales, and Exchange client requests
Provides key insights on Exchange functions using data analysis, industry knowledge and subject matter expertise to identify opportunities, and develop solutions, for optimization of internal business processes and systems
Supports the documentation management of internal policies and procedures, reporting and project specifications, job aids, and workflows for designated Government Programs Operations
Leverages profound knowledge of Exchange guidance and understanding of industry and market requirements to support product strategy and service delivery
Maintains current knowledge of Exchange requirements to facilitate compliance of ongoing business operations
Fosters a high-performance culture through mentoring and collaboration, providing team members with ongoing performance feedback and identifying required changes to existing roles and responsibilities to ensure effectiveness and efficiency
Assesses impact of new business to understand scalability and staffing needs
Qualification
Required
6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange plans
5+ years people management experience
Vast knowledge of Exchange regulatory requirements and associated product and/or operational workflows
Proven success managing multiple complex projects simultaneously
Extremely flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
Excellent written and verbal communication skills
Proven success managing cross functional teams and maintaining effective relationships at all levels both internal and external; including government entities
Company
Capital Rx
Capital Rx is now Judi Health! Navigate to our new page here: https://www.linkedin.com/company/judi-health
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
A. J. Loiacono
CEO
Ryan Kelly
CTO
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