Strategic Leader, Medicare Product Operations

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

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