Senior Manager, Medicare Product Operations (NCOD)

4062 Aetna Resources, LLC; Oklahoma; On-site; USD 75,000 - 183,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement options

Wellness programs

Job summary

CVS Health is seeking a Senior Manager for Medicare Product Operations (NCOD) to lead a team responsible for member determinations, documentation, and appeals-related activities. The role drives compliant, timely outcomes and collaborates with Compliance, Product, Appeals, and Technology to deliver a best-in-class member experience.

The position emphasizes strategic leadership, people management, and continuous improvement in a complex regulatory environment, with opportunities to scale

Qualifications

• 7+ years of Medicare Advantage or related healthcare operations experience.

Responsibilities

• Provide strategic oversight for NCOD operations and ensure alignment with CMS requirements and member experience objectives.
• Oversee end‑to‑end NCOD operations including intake, review, determination, documentation and communication.
• Lead performance management, dashboards, and analytics to monitor KPIs and drive improvement.
• Ensure compliance with regulatory requirements and audit standards through quality assurance activities.
• Collaborate with cross‑functional teams to resolve issues and support enterprise initiatives.

Skills

Medicare Advantage experience

Leadership experience

CMS knowledge

Regulatory translation

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Office Suite

Operational reporting tools

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities. This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience.

Responsibilities Include:

• Strategic Leadership Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives. Establishes operational strategies, and performance standards that support long‑term scalability and sustainability. Leads implementation of new NCOD workflows, benefit offerings, regulatory requirements, operational enhancements, and system improvements. Serves as a subject matter expert and operational consultant for NCODs.
• Operational Management Oversees end‑to‑end NCOD operations, including intake, review, determination, documentation and communication. Ensures 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.
• People Leadership 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, career development planning, and succession planning. Creates an inclusive, collaborative, and high‑performing culture focused on accountability, quality, service, and continuous improvement. Leads workforce engagement initiatives and promotes a positive employee experience through recognition and development. Interviews, hires, develops talent, provides guidance and coaching, and foster a high‑performance culture. Oversees ongoing training to ensure all team members are fully versed and compliant within their respective roles.
• Compliance and Quality Oversight Ensures adherence to CMS regulations, internal policies, audit standards, and organizational determination guidelines. Oversees and participates in quality assurance programs, audit activities, and calibration initiatives. Maintains oversight of documentation standards to ensure decisions are accurate, complete, defensible, and audit‑ready. Partners with Compliance and Operational Integrity teams to assess regulatory changes and implement operational impacts. Identifies and mitigates operational, compliance, and regulatory risks.
• Performance Management and Analytics Establishes and monitors key performance indicators (KPIs), operational dashboards, quality metrics, and service‑level measures. Analyzes operational data to identify trends, root causes, risks, and opportunities for improvement. Presents operational performance updates, recommendations, and strategic insights to senior leadership. Utilizes data‑driven decision‑making to improve quality, efficiency, compliance, and member outcomes.
• Process Improvement and Innovation Leads continuous improvement initiatives focused on operational efficiency, quality outcomes, member satisfaction, and regulatory compliance. Develops and enhances workflows, standard operating procedures, training materials, and operational controls. Identifies workflow optimization strategies, and technology enhancements.
• Cross‑Functional Collaboration Partners with Product, Compliance, Appeals, Grievances, Eligibility, Technology, Vendor Management, customer service, and other stakeholders to resolve issues and improve performance. Builds strong partnerships across the organization to ensure alignment and successful execution of strategic initiatives. Supports enterprise projects, implementations, audits, and regulatory readiness activities.

Required Qualifications

• 7+ years of Medicare Advantage, healthcare operations, compliance, appeals, grievances, organization determinations, supplemental benefits, claims, or related experience.
• 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.

Preferred Qualifications

• Master’s degree in Business, Healthcare Administration, Public Health, Operations, or related field.
• Experience leading Medicare Advantage organization determination, appeals, compliance, or supplemental benefit operations.
• Experience supporting audits, regulatory examinations, or corrective action programs.

Education

Bachelor’s Degree or equivalent experience.

Pay Range

The typical pay range for this role is: $75,400.00 - $182,549.00 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.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Application Window

We anticipate the application window for this opening will close on: 10/10/2026

Discrimination Policy

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

Company Culture

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. Our employees are self‑disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.