Product Manager - Medicare Pharmacy Adjudication

Location: New York, NY - Hybrid (Local to NYC area only)

Position Summary:

Capital Rx is seeking a Product Manager to drive innovation in government pharmacy adjudication, with a focus on Medicare Part D. As a key member of our product organization, you'll develop and enhance solutions that simplify and modernize pharmacy benefits administration for government-sponsored plans.

We're looking for a product manager with experience in pharmacy benefit management (PBM), Medicare Part D, or health insurance who thrives in a fast-paced, highly regulated environment. The ideal candidate will have a strong understanding of claims adjudication, CMS compliance, and Medicare program requirements, coupled with hands-on experience in Agile product delivery and roadmap execution.

This is an opportunity to work at the intersection of healthcare, policy, and technology, solving complex challenges with modern solutions. If you're passionate about improving pharmacy benefits for Medicare beneficiaries and want to make a meaningful impact in a mission-driven, collaborative environment, we want to hear from you!

Position Responsibilities:

• Lead Product Strategy & Execution - Own the development and roadmap for Capital Rx's government pharmacy adjudication (Medicare Part D) products within JUDI, ensuring timely and impactful feature delivery.
• Drive Cross-Functional Collaboration - Partner with engineering, UX, go-to-market, and client-facing teams to prioritize initiatives, enhance user experience, and align on business objectives.
• Analyze & Optimize - Leverage data insights, user research, and stakeholder feedback to drive feature prioritization, improve post-release performance, and anticipate future needs.
• Maintain Agile Development - Oversee backlog management, sprint planning, and scrum ceremonies, ensuring efficient execution and continuous delivery.
• Communicate & Align Stakeholders - Provide regular roadmap updates, product delivery risks, and release notes to leadership, internal teams, and clients.
• Ensure Compliance & Market Fit - Develop business requirements, validate product functionality through user testing, and ensure alignment with Medicare Part D regulations.
• Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Minimum Qualifications:

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  Bachelor's degree in a relevant field (e.g., Business, Computer Science, Healthcare, or related discipline).

  
  
• 3+ years of Product Management experience, preferably in pharmacy benefit management (PBM), health plans, or healthcare technology.
• Expertise in Medicare Part D or government pharmacy adjudication is highly desirable.
• Strong problem-solving skills with the ability to translate complex regulatory and operational challenges into incremental, viable solutions.
• Proven ability to work autonomously, make sound decisions, and drive product initiatives with minimal oversight.
• Excellent prioritization skills, managing conflicting deadlines in a fast-paced, growth-oriented environment.
• Data-driven mindset, with proficiency in SQL, Excel, or data visualization tools to inform decision-making.
• Exceptional communication and collaboration skills, capable of translating between technical and non-technical audiences in both written and verbal formats.
• Detail-oriented with strong project management abilities, ensuring smooth execution from ideation to delivery.
• Curious and adaptable, with a willingness to continuously learn and evolve in a dynamic industry.
• Experience with Agile development methodologies, with Scrum Product Owner certification preferred.
• Familiarity with GitHub or similar source code repositories is a plus.
• Knowledge of Python or other scripting languages is a plus for analyzing complex datasets.

Base Salary: $120,000 - $135,000

Visa Sponsorship: Capital Rx does not provide sponsorship to any candidates. This includes, but is not limited to those that require H1-B, TN, OPT, etc. Candidates must have authorization to work in the US at the time of application and throughout employment.

Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

About Capital Rx

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation's electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp, Capital Rx is executing its mission through the deployment of JUDI, the company's cloud-native enterprise health platform, and a Single-Ledger Model, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Capital Rx 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.

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