Medicare Product Implementation Lead

CVS Health; Alabama; Hybrid; USD 68,000 - 199,000; Full time

Job summary

CVS Health is seeking a Senior Manager, Medicare Product Implementation to lead end-to-end implementation of Medicare Advantage programs with internal stakeholders and external partners. You will gather requirements, develop plans, ensure compliant implementation, and optimize performance while resolving member issues and supporting business objectives.

Strong leadership, project management, and regulatory expertise are essential to drive cross-functional collaboration and successful go-lives

Qualifications

• 7+ years of work experience with Medicare Advantage including supplemental benefits and regulations.
• Experience managing projects and implementations.
• Experience leading cross-functional initiatives.
• Strong planning, problem solving, and communication skills.

Responsibilities

• Act as a top-level specialist and lead end-to-end implementation and ongoing operations for assigned Medicare Advantage programs, ensuring successful implementation, readiness for annual go-live, successful year-over-year delivery, and program operational effectiveness.
• Develop, maintain, and manage key implementation deliverables, including project plans (establish timelines, identify milestones, track progress, identify risks, develop mitigation strategies, track performance metrics, and resource engagement), along with documentation of business and eligibility requirements, member journeys, operational workflows, and benefit crosswalks.
• Facilitate and lead regular project and implementation meetings to drive cross-functional execution across strategy, compliance, eligibility, customer service, member materials, contracting, and other internal and external partners - providing updates and performance metrics to leadership and key stakeholders, addressing inquiries and resolving issues, and ensuring alignment, accountability, and timely delivery of project and program milestones.
• Partner closely with internal and vendor teams to develop program requirements ensuring alignment between benefit intent, design, member experience including benefit access while maintaining strong working relationships.
• Monitor program performance, member access, and utilization while identifying trends, root causes, and opportunities for improvement; identify and resolve operational issues related to eligibility, vendor processes, benefit configuration, and member experience.
• Ensure programs are implemented and operated in compliance with CMS regulations, filed benefit intent, and internal policies; support audits, attestations, and regulatory inquiries.
• Serve as the subject matter expert, make informed decisions and prioritize work across multiple programs and competing deadlines, providing input on operational feasibility, program design, and continuous improvement opportunities.
• Create and maintain a culture of collaboration and cross-functional teamwork, ensuring effective communication and coordination across departments and with leadership.
• Support bid-related activities including strategic discussions, benefit data entry, validation, change tracking, and quality assurance.
• Other duties as assigned.

Skills

Medicare Advantage

Project management

Cross-functional leadership

Regulatory compliance

Stakeholder communication

Education

Bachelor's degree or equivalent experience

Job description

CVS Health is seeking a Senior Manager, Medicare Product Implementation to lead end-to-end implementation of Medicare Advantage programs with internal stakeholders and external partners. You will gather requirements, develop plans, ensure compliant implementation, and optimize performance while resolving member issues and supporting business objectives.

Strong leadership, project management, and regulatory expertise are essential to drive cross-functional collaboration and successful go-lives