Senior Medicare NCOD Operations Leader

NCSL International; Waterbury, Northern (CT, KY); Hybride; USD 75 000 - 183 000; Plein temps

Résumé du poste

CVS Health is seeking a Senior Manager for Medicare Product Operations (NCOD) to lead a multidisciplinary team responsible for fast, accurate, and compliant organization determinations. You will drive process improvements, partner with Compliance, Product, Appeals, and Technology, and ensure a best-in-class member experience.

You will mentor leaders, manage performance, and oversee documentation, training, and regulatory readiness.

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.

Responsabilités

• 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.
• Directly supervises NCOD managers and analysts.
• Establishes clear performance expectations and accountability measures to drive individual and team success.

Connaissances

Medicare Advantage

Healthcare operations

Leadership

Regulatory translation

Organizational skills

Office suite

Operational reporting tools

Formation

Bachelor's Degree

Master's degree (Preferred)

Outils

Operational reporting tools

Microsoft Excel

Description du poste

CVS Health is seeking a Senior Manager for Medicare Product Operations (NCOD) to lead a multidisciplinary team responsible for fast, accurate, and compliant organization determinations. You will drive process improvements, partner with Compliance, Product, Appeals, and Technology, and ensure a best-in-class member experience.

You will mentor leaders, manage performance, and oversee documentation, training, and regulatory readiness.