Government Programs Manager in San Juan, Puerto Rico at Abarca Health

What you’ll do

In a few words… Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

In this position of Government Programs Manager, you will be the voice for key government-driven programs, with a primary focus on Retiree Drug Subsidy (RDS), and serve as a key internal subject matter expert and be responsible for overseeing the accurate, timely, and compliant administration of RDS services on behalf of our clients. You will have your finger on the pulse of CMS RDS guidance, technical specifications, submission requirements, and program changes and will translate those requirements into effective business processes, system requirements, operational controls, and monitoring programs.

As a Program Manager, you will connect the dots across claims, eligibility, financial data, technology, operations, clients, and CMS requirements to ensure the programs are executed completely, accurately, and timely. A Program Manager is energized by translating regulatory guidance into business processes and system requirements. You will help develop and execute monitoring programs to ensure CMS requirements are operationalized accurately and completely and will partner across the organization to support successful program performance. In this role, you will employ your strong analytical, presentation, and communication skills to work with other Abarcans and our clients to solve challenges and develop a #Betterway.

The fundamentals for the job…

• Serve as a government programs process and guidance expert, with a primary focus on RDS, providing strategic and operational guidance to internal teams, clients, vendors, and other stakeholders.
• Own and oversee the end-to-end administration of RDS services, including retiree eligibility, Qualified Covered Retiree (QCR) management, cost reporting, reconciliation, and CMS submissions.
• Drive compliant operational implementation of key initiatives collaboratively with clients, vendor partners, and internal teams.
• Engage directly with clients, vendors, CMS, or auditors as a subject matter expert and strategic consultant.
• Assess regulatory guidance and technical specifications to build or guide processes and requirements that support accurate and timely program administration and CMS reporting.
• Develop strategic workplans and coordinate cross-functional activities to achieve high-quality implementation and ongoing performance of key Medicare Part D initiatives.
• Develop and monitor key performance indicators, controls, and oversight programs to ensure client and CMS requirements are met.
• Analyze deviations from expected results, identify root causes and potential impacts, and coordinate corrective actions.
• Participate in and facilitate requirements discussions related to regulatory, operational, and system changes impacting RDS and other assigned government programs.
• Identify and define enhancements to government program processes and system logic and serve as the business lead/representative, connecting the dots across cross-functional teams.
• Identify, quantify, and communicate regulatory, operational, financial, and client risks and support the development and implementation of appropriate corrective actions.
• Prepare and maintain process documentation and develop training and educational materials for internal and external audiences.
• Identify opportunities to automate, simplify, and strengthen program processes, reducing manual intervention while improving data quality, submission accuracy, financial integrity, and operational efficiency
• Engage with clients and leadership to develop and deliver dashboards, program reporting, and other communications as needed.
• Support CMS, client, internal, and external audits and corrective action plans, including evidence collection, data validation, responses to inquiries, remediation activities, and ongoing monitoring of corrective actions.
• Prepare ad hoc analyses and other materials, including RFP responses, presentations, regulatory impact assessments, and other reporting as needed.

What we expect of you

The bold requirements…

• Bachelor’s or Master’s degree. In lieu of a degree, equivalent relevant work experience may be considered.
• 6+ years of experience in Medicare Part D, pharmacy benefit management, RDS, or related healthcare operations.
• Strong knowledge of Medicare Part D and the Retiree Drug Subsidy program, including eligibility, Qualified Covered Retirees, prescription drug cost reporting, CMS submissions, and financial reconciliation.
• Ability to successfully lead, drive and organize complex, cross functional team projects and initiatives. Demonstrated strategic thinking and planning mindset.
• Creative and curious thinker who can identify challenges, ideate potential solutions, and lead others in implementing changes.
• Highly organized and adaptable, able to work in a fast-paced environment.
• Excellent, concise, and professional presentation skills.
• Ability to clearly articulate arguments, explanations and business requirements with technical and non-technical audiences.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work-days (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to haves...

• Bilingual fluency (English and Spanish).

Physical Requirements

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Abarca Health LLC does not sponsor employment visas at this time.

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.