Special Needs Plans (SNP) Operations Manager

Devoted Health Services, Inc; Waltham (MA); Remote; USD 73,000 - 130,000; Full time

Benefits offered by this job

Health, dental and vision coverage

Generous paid time off

Stock options for all employees

Bonus eligibility for all roles

Job summary

Devoted Health is seeking a Regulatory Compliance professional to lead SNP operations, translating CMS and Medicaid requirements into seamless workflows. You will oversee policies, build early warning systems, and support frontline teams in delivering compliant Medicare and Medicaid services.

You will collaborate with cross-functional teams, manage Model of Care processes, and ensure audit readiness across SNP programs. Remote work is available in the US.

Qualifications

• 3+ years of experience in Medicare Advantage, Managed Care, Health Plan, or health care operations.
• Ability to interpret CMS and/or State Medicaid regulatory guidelines and translate them into standard operational workflows and compliance processes.
• Highly detail-oriented, reliable, independent, and curious, with a track record of managing detailed compliance tasks in a fast-paced environment.
• Strong communication skills with a demonstrated ability to collaborate with and influence cross-functional teams.

Responsibilities

• Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director.
• Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness.
• Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions.
• Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps.
• Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits.
• Oversee, with the SNP Operations Director and other SNP Managers, routine Medicaid reporting, and work cross-functionally to develop and submit required Medicaid reports accurately and timely.
• Provide additional compliance and operational support across SNP and Medicaid programs as assigned.

Skills

Medicare Advantage

Managed Care

Healthcare operations

CMS/Medicaid regulations

Cross-functional collaboration

Job description

Job Description

Job Description A bit about this role: You will join our SNP Operations team, a collaborative team dedicated to building high-performing, compliant operational systems that ensure Devoted’s Special Needs Plans consistently meet rigorous CMS and Medicaid standards. In this role, you will oversee day-to-day regulatory requirements, manage compliance documentation, and handle operational due diligence across our SNP programs. You’ll also drive key process improvements and standardization, ensuring our SNP operations and reporting run smoothly, accurately, and without gaps. Finally, as CMS and Medicaid standards change, you will blend regulatory compliance with operational strategy-translating changing CMS and Medicaid requirements into seamless workflows that empower our frontline teams to deliver exceptional care to our SNP members.

Responsibilities and Impact

• Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director.
• Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness.
• Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions.
• Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps.
• Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits.
• Oversee, with the SNP Operations Director and other SNP Managers, routine Medicaid reporting, and work cross-functionally to develop and submit required Medicaid reports accurately and timely.
• Provide additional compliance and operational support across SNP and Medicaid programs as assigned.

Required Skills and Experience

• 3+ years of experience in Medicare Advantage, Managed Care, Health Plan, or health care operations.
• Proven ability to interpret CMS and/or State Medicaid regulatory guidelines and translate them into standard operational workflows and compliance processes.
• Highly detail-oriented, reliable, independent, and curious, with a track record of managing detailed compliance tasks in a fast-paced environment.
• Strong communication skills with a demonstrated ability to collaborate with and influence cross-functional teams.

Desired Skills and Experience

• Direct experience with Special Needs Plans (SNPs), SNP Model of Care (MOC) development and implementation, or SNP care management operations.
• Experience in the Medicaid space (e.g., Medicaid compliance, benefits administration, claims processing, or D-SNP dual-eligible benefit coordination).

Salary

#LI-Remote Salary Range: $73,000 - $130,000 / year The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Benefits

Our Total Rewards package includes: Employer sponsored health, dental and vision plan with low or no premium Generous paid time off $100 monthly mobile or internet stipend Stock options for all employees Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles Parental leave program 401K program And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

Company Mission

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Equal Opportunity Employer

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business. As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.