Manager, Government Program (D-SNP)

CVS Health

8d

About The Position

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary The D-SNP Program Manager will play a critical role in ensuring annual readiness, regulatory compliance, and strategic alignment of Fully Integrated Dual Eligible Special Needs Plans (FIDE) with business objectives. This position is responsible for assisting the DSNP Market Lead (DML) and Executive Director in implementing and overseeing activities/programs across the market to achieve earnings, growth objectives and support fundamental execution. The ideal candidate is a strong communicator, driven, detail-oriented, collaborative, able to manage multiple projects and priorities at the time and committed to improving member experience and program performance.

Requirements

• 5+ years’ experience working with government programs such as Medicare Advantage Organization (MAO) or Medicaid in one or more of the following areas: Operations, Product, Compliance or D-SNP programs.
• Strong organization skills, creativity, and member focused approach
• Ability to manage multiple priorities, identify trends independently and remediate gaps.
• Proven track record understanding and applying requirements to assure compliance.
• Demonstrated relationship management skills; capacity to quickly build and maintain credible relationships at varying levels externally and within the organization simultaneously
• Skilled and experienced at leading cross-functional work and teams and driving results around the organization.
• Excellent written and verbal communication skills; ability to conduct internal and external presentations and represent the plan.
• Bachelor’s Degree or equivalent experience

Nice To Haves

• Experience with DSNP and/or Medicaid
• Experience with NY FIDE Medicaid Advantage Plus (MAP), Virginia or New Jersey Medicare Advantage (FIDE) Dual Special Needs Plans

Responsibilities

• Oversee all aspects of projects- set deadlines, assign responsibilities, coordinate with cross functional teams, monitor and summarize progress, prepare status reports.
• Proactively evaluates project activities, builds contingency plans, executes corrective actions, and monitors issue resolutions.
• Responsible for reviewing prospect and broker-facing sales material, all required plan materials (ANOC/EOC/SB/PG/PDN), scripts, online enrollment tools, etc. to ensure accuracy and compliance with federal and state requirements.
• Responsible for AEP operational readiness including the creation of education material and training of Sales teams, Customer Service, Operations, Claims, Case Management, etc.
• Partners with Member Experience team, marketing and sales in deploying local member retention and engagement activities, including development and submission of outreach material, design/implementation of outreach programs, and development of talking points/educational pieces about market specific issues.
• Assists with member and community engagement opportunities, including member advisory meetings.
• In partnership with the Product Organization and DSNP Market Lead, the role supports activities and processes including the accuracy and compliance of the annual bid application, expansion application and competitive analysis.
• Assist the D-SNP Market Lead (DML) with ensuring program compliance with federal and state regulations governing FIDE D-SNP programs.
• Partner with D-SNP Market Lead (DML), operations and functional areas in Medicare and Medicaid to address cross-functional issues impacting both Medicare and Medicaid lines of business.
• Represents the D-SNP leadership team by participating in various committees including STARS/Quality, MEU/Trends, Call Calibration, Complaints and Appeals, Bid Process, Product Implementation, AEP Readiness, etc.
• Maintains awareness of trends, developments and governmental regulations in Medicare and managed health care organizations.
• Serves as the back up to the D-SNP Market Lead (DML) for all state regulatory needs.
• Other duties as assigned

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

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