Associate Director Managed Care Operations

The Associate Director will serve as a lead contributor for the CMS Maximum Fair Price (MFP) initiative—a high-visibility federal program spanning design through execution—supporting the development of internal process architecture, helping define business requirements, and taking ownership of day-to-day operations post-launch. Additionally, this role includes designing and implementing an end-to-end process for managed care invoice prefunding with Pharmacy Benefit Managers (PBMs), helping establish this function and serving as a subject matter expert for prefunding workflows and financial controls.

The Associate Director will help advance the application of Artificial Intelligence to drive operational efficiency within Managed Care Operations, supporting the development of AI-powered solutions for formulary validation and identifying opportunities to enhance invoice processing workflows. This role involves assessing emerging technologies, contributing to business cases for AI adoption, and partnering with IT and Data Science teams to help translate innovative concepts into measurable business value.

Beyond these core initiatives, the Associate Director will support the migration to the new Validata platform, manage processing and reporting for all four CMS Inflation Reduction Act (IRA) programs, and play a role in developing team talent and supporting operational continuity across the function. A strong cross-functional collaborator, the Associate Director will work closely with Treasury, Finance, Legal, Strategic Pricing, Government Pricing, Digital, Contract Development, and Account Management teams to align on priorities and deliver measurable results.

Main Responsibilities

• Shape MFP internal process architecture, define business requirements, and manage day-to-day program operations post-launch.
• Coordinate daily payment processing with third-party vendors and ensure ongoing compliance and financial accuracy.
• Design and implement an end-to-end PBM prefunding process with Pharmacy Benefit Managers, including frameworks for tracking, monitoring, and resolving funding discrepancies.
• Coordinate with Treasury, Finance, Account Management, and Operations on funding strategies while serving as primary subject matter expert and process lead.
• Drive tactical implementation of AI to enhance operational efficiency within Managed Care Operations, including developing AI-powered solutions for formulary validation and improving invoice processing workflows.
• Assess emerging technologies, contribute to business cases for adoption, and collaborate with IT and Data Science teams to translate innovations into measurable business value.
• Own end-to-end processing and reporting for all four CMS IRA programs while ensuring strict adherence to regulatory deadlines to avoid penalties and regulatory risk.
• Partner with Finance, Strategic Pricing, and Government Pricing to manage multiple concurrent compliance deadlines with precision.
• Serve as primary business liaison for the transition from the legacy ECP system to the Validata platform, supporting requirements definition, testing, and workflow integration.
• Develop and deliver comprehensive training programs to minimize operational disruption.
• Support SOX control compliance for Managed Care Operations, ensuring adherence to all control requirements and maintaining accurate documentation.
• Coordinate with internal audit activities conducted by PricewaterhouseCoopers (PwC), serving as a key point of contact for audit inquiries, evidence requests, and remediation efforts.
• Process and manage invoices from managed care customers outside the Big 3 customer base, ensuring accurate tracking, timely payment processing, and compliance with contract terms.
• Coordinate with Account Management and Finance to resolve discrepancies and maintain strong vendor relationships.
• Train, mentor, and provide backup coverage for team members during extended absences and vacancies while maintaining cross-functional knowledge to ensure uninterrupted service delivery.
• Partner with Treasury, Legal, Finance, Pricing & Analytics, Digital, Contract Development, and Account Management as a subject matter expert across multiple managed care disciplines.
• Support Director, Managed Care Operations on ad hoc projects as required.

About You

Basic Qualifications:

• Bachelor´s degree required
• Extensive knowledge of Managed Care
• 4 years of Model N experience
• Ability to take ownership of initiatives and drive them to completion
• Strong project management skills
• Financial experience preferred
• Proficient in Microsoft Office Tools, Excel a must
• Ability to collaborate effectively with external vendors
• Strong oral and written communications skills
• Collaborative mindset, consistently fostering teamwork to achieve shared goals and drive organizational success
• Highly organized, meticulous, and detail-oriented, with a disciplined approach and unwavering commitment to delivering superior quality work