Job was saved successfully.
Job was removed from Saved Jobs.

Job Details

CVS Health

Lead Director Medicare Operations





Seattle, Washington, United States

Job Description
**This is a remote position with a preference for qualified candidates on the west coast**

CVS Health/Aetna is working to transform the way members in the Northwest experience health care – improving quality, emphasizing whole-person wellness, and driving down costs. In support of the Chief Medicare Officer, the incumbent has responsibility for ensuring that the local Medicare business is compliantly and effectively operating in the market. As such, the Lead Director of Medicare Operations supports MAPD and SNP initiatives and implements and oversees activities and programs across the market to achieve earnings and growth objectives.

Pay Range
The typical pay range for this role is:
Minimum: 100,000
Maximum: 221,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
• Directs operational functions of Medicare products across a market as directed by the Chief Medicare Officer (acting as Chief Operating Officer).
• Responsible for AEP operational readiness including the education and training of Sales team, tele-sales, and customer service teams.
• Provides operational support for market management of plan sponsors, members, and network providers.
• Serves in a strategic capacity in the bid process as it relates to product and benefit design, competitive analysis, membership modeling, and Contract/PBP strategy.
• Maintains awareness of trends and developments in Medicare and managed health care organizations.
• In partnership with the Product organization, responsible for the oversight and execution, at the local market level, of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, group set up. Uses competitive intelligence to guide, consult and drive product implementation and strategic focus for Medicare Part D and Medicare Advantage.
• Develops Sales & Membership model in conjunction with CMO and Enterprise; accountable to ensure that all customer and broker facing material is accurate and compliant.
• Manages Member Retention Specialist(s) and leads member retention activities, including development of outreach material, design/implementation of outreach programs both directly and in coordination with corporate member retention team, development of talking points/educational pieces about market specific issues.
• Develops and implements business strategies to provide accurate and proactive customer service to members, plan sponsors and brokers
• In partnership with Operations Integrity and at the direction of the Chief Medicare Officer, may facilitate internal and external Medicare audit activity including CMS and operations integrity audits. Coordinates file pulls, data requests, universe development and supporting documentation.
• Maintains current knowledge of State and Federal regulations.
• Monitor sales and marketing activities to assure adherence to Federal and State regulations.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
• Significant (7+) years’ experience in Medicare or equivalent managed care operational and technical skills.
• Subject matter expert in regulations and statutes impacting the Medicare business.
• Ability to perform analysis and legal research to identify and clarify issues.
• Business acumen and experience with managing complex processes.
• Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).
• Excellent written and verbal communication and presentation skills.

• Bachelors’ degree or equivalent experience.

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.