Senior Manager, Duals Operations Strategy

Job DescriptionCollaborative role focused on identification and resolution of operational improvement opportunities Manages the work and deliverables of various products, including but not limited to FIDE/HIDE/MMP products, by monitoring and resolving performance and profitability across multiple processes, systems, functions and workstreams. 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 that support Dual products (MMPS/FIDE/HIDE) administration and operations. Works collaboratively with all enterprise, Medicare, Medicaid functional areas that support orimpact Dual operations. Ensures that systems (administrative and clinical) are aligned with Medicare FIDE/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.Understand and assist to establish critical path milestones, delivery dates, and be comfortable with deliverables to ensure they meet criteria and identify any potential downstream impacts.Collaborates and partners other business areas across/within segments or other business areas to ensure all workflow processes and interdependencies are identified and addressed including trends and gaps.Establish and maintain regular communication related to all workstreams ensuring actions are addressed accurately and timely, identify and assist to implement best practices at both the tactical and strategic level. Focus on operational processes, operational reporting and improvements targeted to support our DNSP members experience.Pay RangeThe typical pay range for this role is:Minimum: 75,400Maximum: 162,700Please 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 This is an individual contributor rolePrevious experience (10+ years) in Medicare Advantage operations including responsibility for leading strategic operational initiativesStrong Medicare Advantage and Duals operations and related systems knowledge including enrollment, claims, network and provider areas, member services, etc. Strong understanding of Medicaid components within Dual productsStrong understanding of Duals operational requirements including related regulations and state Medicaid agency contractsStrong written and communication skills Strong presentation and facilitation skillsAbility to quickly identify gaps and recommends enhancements related to assigned areas.Ability to lead and drive integration requirements across Medicaid and Medicare DualsSolid Project Management skills, including a proven track record in meeting project milestones and negotiating for resourcesAbility to adapt to rapidly changing business environment and technologyPreferred Qualifications Excellent communication skills both written and verbal Experience with Compliance and Regulatory oversightEducation BS/BA or equivalent experienceBusiness OverviewBring 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. 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