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…

Providing high quality services to clients and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Our GPS, (Government Programs & Services) teams handle direct contact, data transfers, issue management, auditing, and much more for any state or federal agencies as well as government led programs. No one else in this division can talk the talk and walk the walk on Medicare and Medicaid services like they can!

In the role of GPS Regulatory Communications Program Manager, you are responsible for ensuring written communications sent to external parties are generated accurately and timely according to regulatory requirements and client agreements, while meeting all the standards required for successful processing internally or by our mail vendor. You need to be knowledgeable about the regulatory requirements that apply to Member or Prescriber communications and the internal end-to-end process of each communication type, from letter template definition, batch generation, printing, and mailing, to validation.

The fundamentals for the job…

• Analyze, trend, and track written communications for all lines of business. Keep an inventory of the most current approved letter templates by topic and by client, with applicable requirements.
• Stay up to date with regulatory requirements and best practices pertaining to mailing timeliness and communication requirements.
• Ensure communications requirements are followed in accordance with policies and procedures as well as regulatory guidance.
• Engage directly with clients, auditors and vendors as a subject matter expert and strategic consultant.
• Develop tools to document and perform monitoring activities for determining if letters are compliant with regulatory requirements, accurate content, approved templates, and mailing timeliness.
• Work with areas to identify root cause of issues pertaining to letter processes and ensure any findings are promptly corrected and documented properly.
• Assist in issue management processes related to communications processes and/or vendor performance to ensure corrective actions are performed, including testing and ongoing monitoring.
• Manage relationship with print and mailing delegated entities to ensure compliance with SLA’s and contracted functions.
• Facilitate discussions related to changes that may impact file exchanges between Abarca’s technical team and print and mailing vendor(s).
• Participate and facilitate discussions related to change that may impact regulatory communications. Prepare and maintain process documentation supporting regulatory communication processes and logics for internal and external audiences.
• Develop internal and client training programs and cadence, facilitate execution.
• Engage directly with clients and leadership to develop, modify, and deliver dashboards and other required reporting as needed.
• Identify, quantify, and communicate areas of risk and develop corrective actions.
• Support creation of internal and external CAPs; oversee implementation of remediations, monitor efficacy of corrective actions.
• Collaborate with client implementation team as needed for process requirements gathering, configuration, E2E testing and go-live process.
• Prepare ad hoc analysis and other reports such as RFP responses, presentations, among others.

 What we expect of you 

The bold requirements…

• Bachelor’s Degree or Master’s Degree in a related field. (In lieu of a degree, equivalent relevant work experience may be considered.).
• 6+ years of experience within a similar role in government related programs.
• Experience the Healthcare industry (PBM, Pharmacy, Insurance, CMS plan audits).
• Experience working with PBM Operations, Medicare Part D, Auditing and Monitoring, CMS Program Audits & Protocols.
• Excellent writing skills with high levels of negotiating capabilities and proper presentation skills.
• Experience in vendor management.
• Excellent oral and written communication skills.

Nice to haves…

• Bilingual fluency in Spanish and English.

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.  “Applicant must be a United States’ citizen. 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.

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