Program Manager, Solution Innovation

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Establish and uphold the long-term product vision, strategy, and roadmap for PSAO Audit and Compliance Solutions.

• Convert Group Product Owner priorities into a results-oriented roadmap.

• Utilize customer insights, audit trends, regulatory changes, operational feedback, and stakeholder contributions to prioritize enhancements to the product.

• Take ownership of the Pharmacy Audit Support product, including its features, processes, and improvements.

• Spearhead the design and ongoing enhancement of audit support workflows, reporting, case management, issue escalation, and enablement tools.

• Collaborate with internal teams and external stakeholders to enhance audit results and minimize recoupment risk.

• Use AI and technology to upgrade Pharmacy Audit Support offerings and drive operational efficiencies.

• Ensure PSAO offerings adhere to relevant federal, state, and local laws, rules, regulations, and obligations.

• Manage and monitor PSAO registration and licensure requirements, compliance timelines, and necessary documentation.

• Keep track of regulatory and licensure changes and adjust processes, product capabilities, controls, and communications accordingly.

• Oversee updates to policies and procedures.

• Monitor participating pharmacies and providers for suspicious, fraudulent, or high-risk activities using both internal and external data.

• Work with Central Pay, contracting, finance, and related teams on payment-integrity and compliance risks.

• Contribute to the development of preventative and corrective action plans, policy enhancements, and control improvements.

• Maintain and prioritize a product backlog.

• Lead roadmap planning, release coordination, and comprehensive delivery in partnership with cross-functional stakeholders.

• Align cross-product roadmap dependencies with the broader PSAO solution strategy.

• Engage users and stakeholders to gather requirements, validate workflows, and enhance solution usability and effectiveness.

• Support policies, procedures, controls, and documentation related to compliance obligations.

• Coordinate compliance training, communications, and enablement resources.

• Promote standardized operational methods and ensure audit readiness.

• Define and monitor KPIs related to audit support utilization, compliance timeliness, registration and licensure completion, issue resolution, risk indicators, and business impact.

• Report on product performance, operational trends, compliance status, risks, and opportunities for improvement to leadership.

• Evaluate adoption, efficiency, customer value, and cost-benefit outcomes to refine priorities.

⛳️ Requirements

• Bachelor's degree required; advanced degree preferred in business, healthcare, pharmacy, regulatory affairs, compliance, or related fields.

• Generally requires 7+ years of progressively responsible experience in compliance, audit support, regulatory operations, pharmacy services, product management, or a related field.

• Strong grasp of pharmacy operations, payer and PBM audit dynamics, regulatory compliance, and registration/licensure requirements in healthcare or pharmacy-related contexts.

• Proven track record of defining product roadmaps, prioritizing enhancements, leading cross-functional delivery, and translating stakeholder needs into scalable solutions.

• Exceptional analytical, communication, organizational, and stakeholder management abilities.

• Capability to influence decisions and drive outcomes within a matrixed environment.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Backup dependent care services.

• Adoption assistance programs.

• Infertility treatment coverage.

• Support for family building initiatives.

• Behavioral health solutions.

• Paid parental leave.

• Paid caregiver leave.

• Access to training programs.

• Resources for professional development.

• Mentorship opportunities.

• Employee resource groups.

• Opportunities for volunteer activities.