Associate Director Managed Care Operations
Core
Lead operational, regulatory, and technological functions for Managed Care Operations, focusing on CMS Maximum Fair Price (MFP) initiative, PBM prefunding processes, and AI-driven efficiency improvements.
Role type
Senior IC managed care operations lead
Builds
End-to-end PBM prefunding workflows, AI-powered formulary validation and invoice processing solutions, and reporting for CMS Inflation Reduction Act (IRA) programs
Domain
Biopharma / Managed Care / Regulatory Compliance
Deliverable
production ML models | product features | dashboards & analysis
Required skills
Managed care industry expertise, Model N platform proficiency, project management, financial experience, regulatory acumen, Microsoft Excel proficiency
Preferred skills
AI/ML adoption experience, SOX control compliance knowledge, change management
Technologies
Model N, Validata platform, Microsoft Office (Excel)
Responsibilities
Shape MFP internal process architecture and manage day-to-day operations; Design and implement PBM prefunding processes; Drive tactical implementation of AI for formulary validation and invoice processing; Own processing and reporting for four CMS IRA programs; Lead transition from legacy ECP system to Validata platform; Support SOX control compliance and coordinate with internal audit; Process invoices for managed care customers outside the Big 3
Seniority
Senior, hands-on IC