Judi Health
Healthcare
SeniorManagerGovernmentProgramOperations(Exchange)
“Senior Manager Government Program Operations (Exchange) at Judi Health. Skills: leading the end‑end implementation, governance, and change management of regulatory requirements for Exchange plans and EDGE Server operations, overseeing the delivery of CMS submissions, compliance activities, contract applications, and bid‑related client support, coordinating responses to federal and state regulatory audits, ensuring all regulatory reporting obligations are met for Exchange clients. Lead Government”
Industry & Context.
structured research; analysis; testing; validation; data analysis; identify opportunities; develop solutions
What They're Looking For.
Must Have
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 including government entities
What You'll Do.
Lead Government Programs support for Exchange business functions including claims adjudication
and audit support (Government
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
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
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
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
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.
How You'll Work.
Team & Collaboration
Partners with cross‑functional SMEs; Fosters a high-performance culture through mentoring and collaboration
Process & Methodology
managing multiple complex projects simultaneously
Applying for this Senior Manager Government Program Operations (Exchange) role?
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