The Director of Medicare Part D Clinical Configuration is a member of the Coverage Determinations and Appeals (CD&A) Leadership Team and has accountability for the quality and successful configuration of all Prior Authorization decision criteria, written communications to beneficiaries and prescribers, and all other configurable elements of the MedHOK CD&A system.This role leads a team of over 90 individuals responsible for (i) understanding the CD&A system, work flows, and Medicare Part D regulations, (ii) gathering and understanding the intentions of all client requirements and timelines, (iii) accurately configuring the MedHOK CD&A system to successfully meet all client requirements and timelines, (iv) comprehensive testing and validation of configuration to ensure accuracy, consistency, timeliness, and 100% Medicare Part D compliance.The Director of Medicare Part D Clinical Configuration is accountable for ensuring that all plan requirements, Medicare Part D regulations, and business objectives of the Coverage Determinations and Appeals operation are fully understood and applied accurately and consistently. This role will also have strategic ownership and responsibility for the following:
- Consistent monitoring for changes in clinical criteria, letter templates, relevant regulations, and other technology solutions that impact the configuration function
- Sponsoring IT projects that ensure MedHOK Configuration is at all times compliant
- Sponsoring work flow and IT solutions that lead to improved efficiency and accuracy in Configuration, Testing, Validation, and or CD&A Operations processes
- Establishing a best practice model for interfacing with clients and partnering internally to gather high-quality requirements in an efficient and timely way to lead to accurate, compliant, and timely outcomes for clients, their beneficiaries, and the CD&A operation
- Creating an efficient and accurate budget/forecasting model
- Creating the robust oversight protocols and processes that provide constant compliance performance monitoring
- Building and developing a high performing, highly engaged Configuration team
- Ensure all policy and procedure documentation is up to date and accurate
- Respond timely to CMS, client or other submitters of regulatory issues involving MedHOK Configuration
- Supporting internal Client Audit teams as needed during CDAG audits by CMS and Clients
This Director of Medicare Part D Clinical Configuration will have frequent visibility to senior leadership and strategic client relationships through updates on Configuration results validation, strategic projects, and other high profile Medicare Part D clinical initiatives.
This position must be located in our Richardson, TX office location. The Director of Medicare Part D Clinical Configuration must be able to travel minimally (20% or less).