Medicare NCOD Operations Leader — Strategy & Compliance

NCSL International; Scottsdale (AZ); On-site; USD 75,000 - 183,000; Full time

Job summary

CVS Health seeks a Senior Manager to lead Medicare Product Operations (NCOD), ensuring accurate, timely organization determinations and member-centric service. You will manage managers and analysts, drive regulatory compliance, and partner with Compliance, Product, Appeals, and Technology to deliver best-in-class outcomes.

This role focuses on strategic leadership, operational excellence, and continuous improvement across NCOD workflows, with a strong emphasis on performance measurement and

Qualifications

• 7+ years in Medicare Advantage, healthcare operations, compliance, or related fields.
• 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.

Responsibilities

• Provide oversight for the NCOD operation, including intake, review, determination, documentation and communication.
• Ensure compliance with established turnaround times, and regulatory requirements.
• Monitors workload distribution, staffing needs, productivity trends, and inventory management.
• Leads operational readiness planning for benefit, process, policy, and technology changes.
• Directly supervises NCOD managers and analysts.
• Establishes clear performance expectations and accountability measures to drive individual and team success.
• Coaches, mentors, and develops staff through ongoing feedback, performance management planning and succession planning.
• Creates an inclusive, collaborative, and high-performing culture focused on accountability, quality, service, and continuous improvement.

Skills

Medicare Advantage knowledge

Leadership

Regulatory compliance

Operational processes

Prioritization

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Office Suite

Job description

CVS Health seeks a Senior Manager to lead Medicare Product Operations (NCOD), ensuring accurate, timely organization determinations and member-centric service. You will manage managers and analysts, drive regulatory compliance, and partner with Compliance, Product, Appeals, and Technology to deliver best-in-class outcomes.

This role focuses on strategic leadership, operational excellence, and continuous improvement across NCOD workflows, with a strong emphasis on performance measurement and