Senior Manager Government Program Operations (Exchange)

Overview Judi Health is an enterprise health technology company offering comprehensive solutions for employers and health plans, including Capital Rx, Judi Health™, and Judi® – the industry’s leading proprietary Enterprise Health Platform (EHP). Our mission is to rebuild trust in healthcare in the U.S. by providing scalable, secure platforms that consolidate claim administration workflows. Location Remote (for non‑local) or Hybrid (local to Denver or NYC area) Position Summary The Senior Manager leads the end‑to‑end implementation, governance, and change management of regulatory requirements for Exchange plans and EDGE Server operations. Responsibilities include overseeing CMS submissions, compliance activities, contract applications, bid‑related client support, and responses to federal and state regulatory audits. The role ensures all regulatory reporting obligations are met by interpreting CMS and state guidance, partnering with internal subject matter experts, and translating requirements into operational processes. Using structured research, analysis, testing, and validation, the Senior Manager ensures systems, workflows, and data submissions consistently meet regulator expectations and client objectives. Nothing in this position description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Responsibilities Lead Government Programs support for Exchange business functions including claims adjudication, regulatory reporting, and audit support. Interpret, implement, and monitor all relevant regulatory requirements and changes impacting Capital Rx’s Exchange Programs. Establish and maintain the EDGE pharmacy submission playbook (file intent, lineage, duplicate controls, timestamp standards, enrollment alignment). Define and enforce submission cadences, pre‑submission QA gates, and accept/active/non‑orphan targets that meet CMS sufficiency timelines. Translate CMS updates into operational SOPs and training. Partner with cross‑functional SMEs to analyze regulatory changes, determine implications for processes, systems, and client commitments, and lead coordinated, on‑time implementation across the enterprise. Manage timely responses to Government Programs support for RFP/RFI, internal sales, and Exchange client requests. Provide key insights using data analysis to identify opportunities and develop solutions for optimizing internal business processes and systems. Support documentation management of internal policies, procedures, reporting, project specifications, job aids, and workflows for Government Programs Operations. Leverage profound knowledge of Exchange guidance to support product strategy and service delivery. Maintain current knowledge of Exchange requirements to facilitate compliance of ongoing operations. Foster a high‑performance culture through mentoring, collaboration, ongoing performance feedback, and defining role effectiveness. Assess impact of new business to understand scalability and staffing needs. Qualifications 6+ years of relevant Prescription Benefit Management and/or Health Plan experience supporting Exchange plans. 5+ years of people management experience. Vast knowledge of Exchange regulatory requirements and associated product and/or operational workflows. Proven success managing multiple complex projects simultaneously. Extremely flexible, highly organized, and able to shift priorities easily. Attention to detail & commitment to delivering high‑quality work. Excellent written and verbal communication skills. Proven success managing cross‑functional teams and maintaining effective relationships at all levels, including government entities. Salary Range

$120,000—$135,000 USD

Code of Conduct All employees are responsible for adherence to the Capital Rx Code of Conduct, including the reporting of non‑compliance. EEO Statement Judi Health values a diverse workplace and celebrates the diversity that each employee brings to the table. 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. Privacy Notice By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at #J-18808-Ljbffr Capital Rx