Lead Director, DSNP Program Management

CVS Health • Prior Lake, VT

9d

About The Position

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 Plans, monitors and manages internal projects from initiation through completion for the Georgia and the Gulf States Medicare Market. Secures required resources and uses formal processes and tools to manage resources, budgets, risks and changes. Manages projects to ensure on-time completion according to specifications and within budgeted costs. At the higher levels, incumbents manage large multifaceted projects; at lower levels, incumbents may be concerned with clearly identifiable elements or functions within a larger project. Typically incumbents matched to this function are working towards or have achieved certification in project management. What you will do Directs teams throughout the development, implementation, and execution of the Dual Eligible Special Needs Plan (DSNP) program that provides specialized care for individuals who are eligible for both Medicare and Medicaid (dual eligible beneficiaries). Applies advanced knowledge of the Medicare and Medicaid regulatory landscape to ensure program compliance with federal and state regulations governing DSNP programs. Conducts advanced research on innovative healthcare delivery models that may enhance the impact of the DSNP program. Consults on critical quality metrics for the DSNP program with stakeholders and implements evidence-based interventions to optimize program outcomes and improve member experiences. Develops methods for monitoring program expenditures and financial resources while maintaining program quality and compliance. Collaborates with healthcare providers, care managers, social workers, and other stakeholders to ensure integrated and coordinated care for dual eligible beneficiaries. Evaluates the feasibility of integrated care models, care coordination strategies, and telehealth solutions for DSNP members. Develops strategies for identifying and enrolling eligible individuals into the DSNP program, and provides support to beneficiaries throughout the enrollment process. Coordinates the development and dissemination of educational materials and resources to beneficiaries to help them understand their benefits and access appropriate care.

Requirements

• 10+ years work experience
• 5+ years working within a Medicare Advantage Organization
• Mastery of problem solving and decision making skills
• Mastery of collaboration and teamwork
• Mastery of growth mindset (agility and developing yourself and others) skills
• Mastery of execution and delivery (planning, delivering, and supporting) skills
• Mastery of business intelligence
• Bachelor's degree required

Nice To Haves

• 3+ years working with Medicare Special Needs Plans
• Graduate degree preferred

Responsibilities

• Directs teams throughout the development, implementation, and execution of the Dual Eligible Special Needs Plan (DSNP) program that provides specialized care for individuals who are eligible for both Medicare and Medicaid (dual eligible beneficiaries).
• Applies advanced knowledge of the Medicare and Medicaid regulatory landscape to ensure program compliance with federal and state regulations governing DSNP programs.
• Conducts advanced research on innovative healthcare delivery models that may enhance the impact of the DSNP program.
• Consults on critical quality metrics for the DSNP program with stakeholders and implements evidence-based interventions to optimize program outcomes and improve member experiences.
• Develops methods for monitoring program expenditures and financial resources while maintaining program quality and compliance.
• Collaborates with healthcare providers, care managers, social workers, and other stakeholders to ensure integrated and coordinated care for dual eligible beneficiaries.
• Evaluates the feasibility of integrated care models, care coordination strategies, and telehealth solutions for DSNP members.
• Develops strategies for identifying and enrolling eligible individuals into the DSNP program, and provides support to beneficiaries throughout the enrollment process.
• Coordinates the development and dissemination of educational materials and resources to beneficiaries to help them understand their benefits and access appropriate care.

Benefits

• 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.
• 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.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees