Senior Manager, Medicaid Operations

Role Summary

The Senior Manager, Medicaid Operations leads critical operational, analytical, and compliance activities to safeguard against revenue leakage. This role partners with cross-functional teams—including Legal, Government Pricing, Trade, and Reimbursement—as well as external stakeholders to identify, investigate, and resolve 340B duplicate discount issues. The Senior Manager defines and drives operational excellence to ensure full compliance with federal and state Medicaid program requirements. The ideal candidate brings strong Medicaid Rebate operations expertise and in-depth knowledge of the 340B program, with a proven ability to lead operational processes in evolving regulatory environments.

Responsibilities

• Lead the Medicaid team’s efforts to develop processes and controls to identify, investigate, and resolve 340B duplicate discounts.
• Leverage data to guide 340B inquiries and enhance operational controls.
• Work with internal stakeholders to develop methodologies to detect potential duplicate discounts using state-claim-level data, HRSA 340B registry, and claims validation tools.
• Partner with external stakeholders, including state Medicaid agencies, 340B covered entities, and third‑party administrators, to determine the validity of disputes and ensure compliant resolution.
• Serve as the subject matter expert on duplicate discount regulations, HRSA guidance, and industry best practices.
• Review quarterly Medicaid and State Supplemental Rebate invoices to confirm accuracy, timeliness, and compliance with contract terms.
• Drive process optimization initiatives to increase accuracy, efficiency, and transparency in Medicaid contract operations.
• Support audits, internal reviews, and compliance assessments related to Medicaid and 340B programs.
• Monitor emerging federal and state policy changes that impact Medicaid operations and guide the team in proactive adaptation.
• Maintain dashboards, analytical tools, and reports that provide insights into Medicaid and 340B trends, risks, and operational performance.

Qualifications

• Required: Bachelor’s degree.
• Preferred: Advanced degree (MBA, MPH, etc.).
• Required: 5+ years of experience in Medicaid, government pricing, contract operations, 340B program management, or related pharmaceutical/healthcare fields.
• Required: Advanced Excel skills and knowledge of ModelN or a comparable rebate operation system.
• Required: Strong analytical skills with the ability to interpret large data sets and compile evidence, to accelerate dispute resolutions.
• Required: Strong knowledge of Medicaid Drug Rebate Program (MDRP), 340B program regulations, HRSA guidance, and state Medicaid operations.
• Required: Demonstrated experience leading operational teams in a matrix reporting structure.
• Required: High attention to detail, strong organizational skills, and ability to manage multiple priorities.
• Required: Excellent communication, influence, and problem-solving skills.
• Required: Ability to synthesize complex information and clearly communicate to leadership stakeholders.

Education

• Bachelor’s degree required; Advanced degree preferred.