Senior Manager Government Program Operations (Exchange)

📋 Description

• • The Senior Manager Government Program Operations (Exchange) leads the end-to-end implementation, governance, and change management of regulatory requirements for Exchange plans and EDGE Server operations at Capital Rx, a public benefit corporation focused on rebuilding trust in healthcare through innovative pharmacy benefit management and enterprise health platforms.
• • Day-to-day responsibilities include leading Government Programs support for Exchange business functions such as claims adjudication, regulatory reporting, and audit support; establishing and maintaining the EDGE pharmacy submission playbook; defining submission cadences and QA gates; translating CMS updates into operational SOPs and training; partnering with cross-functional SMEs to analyze regulatory changes; managing responses to RFPs/RFIs and client requests; providing data-driven insights for process optimization; supporting documentation management of policies and workflows; leveraging Exchange expertise to inform product strategy; maintaining current knowledge of Exchange requirements; fostering a high-performance culture through mentoring and feedback; and assessing scalability and staffing needs for new business.
• • The team operates within Judi Health, an enterprise health technology company that delivers integrated solutions including Capital Rx (PBM for self-insured employers), Judi Health™ (health benefit management for employers, TPAs, and health plans), and Judi® (the industry-leading Enterprise Health Platform consolidating claim administration workflows). The company is mission-driven, focused on rebuilding trust in U.S. healthcare through scalable, secure technology.
• • In this role, the individual will develop deep expertise in CMS and state Exchange regulatory frameworks, enhance leadership and change management skills, drive operational excellence in government program compliance, influence product strategy through regulatory insights, and gain experience managing complex, cross-functional initiatives in a fast-growing, purpose-driven health technology organization.