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Senior Manager, Medicare Product Operations
CVS Health. Provide leadership, operational oversight, and people management for the Non-Clinical Organization Determination team .
About the role
Key responsibilities & impact- Provide leadership, operational oversight, and people management for the Non-Clinical Organization Determination team
- Ensure accurate, timely, compliant, and member-centered coverage determinations
- Oversee end-to-end NCOD operations, including intake, review, determination, documentation, and communication
- Lead implementation of workflows, benefit offerings, regulatory requirements, operational enhancements, and system improvements
- Monitor turnaround times, workload distribution, staffing needs, productivity trends, and inventory management
- Lead operational readiness planning for benefit, process, policy, and technology changes
- Directly supervise NCOD managers and analysts
- Coach, mentor, develop, and evaluate staff; oversee hiring, training, performance management, career development, and succession planning
- Ensure adherence to CMS regulations, internal policies, audit standards, and organization determination guidelines
- Oversee quality assurance programs, audit activities, calibration initiatives, and documentation standards
- Establish and monitor KPIs, operational dashboards, quality metrics, and service-level measures
- Analyze operational data and present performance updates, recommendations, and strategic insights to senior leadership
- Lead continuous improvement initiatives and enhance workflows, procedures, training materials, and operational controls
- Partner with Product, Compliance, Appeals, Grievances, Eligibility, Technology, Vendor Management, Customer Service, and other stakeholders
- Support enterprise projects, implementations, audits, and regulatory readiness activities
Requirements
What you’ll need- 7+ years of Medicare Advantage, healthcare operations, compliance, appeals, grievances, organization determinations, supplemental benefits, claims, or related experience
- 3+ years of leadership experience managing teams
- Strong knowledge of Medicare Advantage regulations, CMS guidance, organization determinations, appeals, grievances, and supplemental benefit administration
- Experience translating regulation requirements into operational processes and controls
- Advanced organizational and prioritization skills with the ability to manage multiple competing priorities
- Proficiency in Microsoft Office Suite and operational reporting tools
- Bachelor’s Degree or equivalent experience
- Master’s degree in Business, Healthcare Administration, Public Health, Operations, or related field preferred
- Experience leading Medicare Advantage organization determination, appeals, compliance, or supplemental benefit operations preferred
- Experience supporting audits, regulatory examinations, or corrective action programs preferred
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program
- Equity award program
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being