Product Management Advisor – Medicare Solutions - Express Scripts - Hybrid
Core
Translate complex Medicare regulations into actionable product enhancements and business processes to ensure compliance and operational excellence for Medicare Advantage, Part B, and Part D programs.
Role type
Product Management Advisor (Medicare Solutions)
Builds
Medicare Advantage, Medicare Part D, Medicare Part B, and MOOP-related initiatives
Domain
Healthcare / Health Insurance / Pharmacy Benefit Management (PBM)
Deliverable
product features
Required skills
Medicare regulations interpretation, product management, project leadership, regulatory compliance analysis, stakeholder influence, Agile methodologies, data analysis, documentation
Preferred skills
PBM operations (pharmacy adjudication), Agile product development, SQL, Microsoft Access, NCPDP/PCMA standards knowledge, client presentation
Technologies
SQL, Microsoft Excel, Microsoft Access
Responsibilities
Monitor and interpret CMS regulations to translate requirements into product enhancements; Lead implementation of Medicare Advantage, Part D, Part B, and MOOP initiatives; Analyze performance trends and compliance metrics to identify improvement opportunities; Support internal and external audits with documentation and expertise; Develop training and communications for clients and internal teams; Establish policies and procedures to support compliance and operational consistency