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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.

Position Summary

In support of the Chief Medicare Officer, the candidate 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. 

Position Duties & Responsibilities

• Directs operational functions of Medicare products across a market as directed by the Chief Medicare Officer.
• Drives successful market results by improving provider and vendor performance, as well as implementing tactics to address emerging claims experience.   
• Responsible for AEP operational readiness including the education and training of Sales team, telesales, and customer service teams.
• Provides operational support for market management of plans, members, network providers, and distribution partners.
• Serves in a strategic capacity overseeing value based provider contracting and performance.
• 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.
• 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 Chief Medicare Officer, Sales Center of Excellence, and Enterprise; accountable to ensure that all customer and broker facing material is accurate and compliant.
• Manages 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.

Required Qualifications:

• 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.

Education

• Bachelors’ degree or equivalent experience

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. 
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/20/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.