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Magellan Health Services, Inc.

Pharmacy Program Manager - Medicare

Magellan Health Services, Inc. - Harrisburg, PA

Pharmacy Program Manager - Medicare

Manages the coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership skills that ensure successful Part D pharmacy operations and program compliance within the pharmacy business unit. Makes business decisions that have impacts on members, providers, Part D plans, CMS, and the company. Requires a working knowledge of Medicare Part D eligibility requirements, Part D plan designs, drug formularies, drug pricing, claims processing and reimbursements, True Out of Pocket expenditures, that ensure successful Part D pharmacy operations and Senior Pharmaceutical Asistance Program compliance within the pharmacy department. Works with state program leaders, ensures established rules, policies, and procedures are implemented to ensure coordination of Medicare Part D operations are successful, efficient, auditable and in compliance with CMS requirements. 


- Ensures the accuracy of payments to Part D sponsors having signed agreements with the Pennsylvania Department of Aging (PDA), a qualified SPAP. These payments include but are not limited to premium amounts, late enrollment penalties, and reimbursement of drug claims.

- Ensures the accuracy of payments to Part D sponsers for the Pennsylvania Department of Health's Aids Drug Assistance Program (ADAP) who has a memorandum of understanding with PDA to meet this objective.

- Resolves disputes of payments with the Part D plans, on a timely basis, and acts as a liaison between PDA and the Part D plan.

- Receives, interprets, and acts upon CMS guidance where necessary and applicable to the SPAP programs.

- Consults with PDA staff members to identify and document business needs and objectives, and consults with internal staff and PDA staff members to identify and document current operational procedures, and evaluates alternatives applicable to system development activities.

- Provides technical assistance and guidance in identifying, evaluating, and developing systems and procedures, and tracks and documents changes to functional and business specifications.

- Creates or assists others in the writing of user documentation, instructions, and procedures, assists in the creation and execution of acceptance test plans and the associated testing and monitors and documents post-implementation problems and revision requests.

- Assists PDA with writing the annual RFI and evaluating submitted responses from Part D plans. Analyzes and interprets data and provides guidance in the plan selection.

Job Requirements


Bachelors: Business Administration (Required)


At least five years experience administering a pharmacy benefit for SPAPs and ADAPs coordinated with Medicare Part D. 
Familiarity with all facets of the business, including but not limited to enrollment, invoicing, reconciliations, recoupment activities, electronic file submission and retrieval, and customer service.
Excellent ability to communicate orally and in writing to varied audiences including state government program leaders, Medicare Part D plans, pharmacy providers and members.
Understands the impact coordination of benefits has on other operational areas including member and pharmacy call center customer service.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled

9 days 18 hours ago

Magellan Health Services, Inc.


Pharmacy Program Manager - Medicare Magellan Health Services, Inc. - Harrisburg, PA, United States


Location: Harrisburg, PA

Company Profile:
As a health care management company, we focus on today's most complex and costly health care services. The depth and breadth of our experience in managing behavioral health care, diagnostic imaging, specialty pharmaceutical services and in providing pharmacy benefits administration enable us to deliver inspired insights and innovative solutions that positively impact both the quality and the cost of some of the nation's fastest growing areas of health care.