Senior Manager, Duals Operations Strategy

Job DescriptionCollaborative role focused on identification and resolution of operational improvement opportunities Manages the work and deliverables of duals products, through to implementation that impact multiple processes, systems, functions and products. This includes interfacing with all key stakeholders (e.g., markets, sales, operations, etc.) to identify opportunities to improve operational processes, reporting and performance management, and accountability for the systems that support duals products (DSNPs and MMP) administration and clinical operations. Works collaboratively with all enterprise, Medicare, Medicaid functional areas that support orimpact duals operations. - Ensures that systems (administrative and clinical) are aligned with Medicare DSNP/MMP requirements (administrative and model of care), product and benefit designs, and state Medicaid agency contract requirements.- Works with functional areas to ensure that systems and processes are appropriately structured to drive enrollment, claims, care management, customer and provider services, member and provider facing portals or tools, etc.- Lead must understand related operations and process that support these functions. Will support planning and implementation of DSNP integration and data sharing requirements.- Collaborates and partners other business areas across/within segments or other business areas to ensure all workflow processes and interdependencies are identified and addressed.- Accountable to ensure all member internal/external portals are appropriately configured and displayed for all DSNP requirements working with product and other stakeholder. This includes but is not limited to accumulators, cost share displays, alignment with DSNP member materials etc.- Focus on operational processes, operational reporting and improvements targeted to support our DNSP members experienceRequired Qualifications- Previous experience (10+ years) in Medicare Advantage operations including responsibility for leading strategic operational initiatives- Strong Medicare Advantage and DSNP operations and related systems knowledge including: enrollment, claims, network and provider areas, member services, etc. - Strong understanding of DSNP operational requirements including related regulations and state Medicaid agency contracts- Strong written and communication skills - Strong presentation and facilitation skills- Ability to quickly identify gaps and recommends enhancements related to assigned areas.- Ability to lead and drive integration requirements across Medicaid and Medicare DSNP- Solid Project Management skills, including a proven track record in meeting project milestones and negotiating for resourcesCOVID RequirementsCOVID-19 Vaccination RequirementCVS 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- Medicaid managed care knowledge desiredEducationBachelor's degree or equivalent experienceMasters Degree preferredBusiness OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2024-10-19