Medicare Senior Manager, DSNP Market

CVS Health

6d

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 The Senior Manager will work alongside duals leaders to drive overall performance, compliance and health of the duals product. Primary responsibilities include collaborating with internal and external partners to support growth, retention, engagement, and regulatory compliance efforts. This highly collaborative role requires effective cross-functional partnership with local markets, enterprise, and Government Services teams, as well as the DSNP Program Office, to achieve business goals while maintaining alignment with evolving requirements and standards.

Requirements

• 6+ years’ experience in one or more of the following at a managed care or provider organization: DSNP programs, Managed Care Operations, Medicare Advantage
• Demonstrated relationship management skills; capacity to quickly build and maintain credible relationships at varying levels externally and within the organization simultaneously
• Strong organization skills, creativity, and member focused approach
• Proven track record understanding and applying requirements to assure compliance.
• Skilled and experienced at leading cross-functional work and teams and driving results around the organization.
• Ability to manage multiple priorities, identify trends independently and remediate gaps.
• Experiencing with product performance and tactically execution to drive results
• Work location: NJ, NY, Virginia

Nice To Haves

• Experience with Duals Integrated Products
• Experience with State Regulators in NJ, NY & or Virginia
• Bachelor’s Degree or equivalent experience preferred

Responsibilities

• Ensures timely and accurate management of state-specific compliance requirements, including maintaining and responding to regulatory mailboxes, coordinating with state agencies, and supporting all required state-level reporting, submissions, and audits.
• Acts as the primary point of contact for state interactions related to DSNP compliance, proactively addressing issues and ensuring ongoing alignment with evolving state policies
• Understands and translates requirements to ensure DSNP is compliant with state and CMS regulations
• Understand product performance indicators to drive tactical improvements.
• Works with the sales and marketing teams to establish sales and member retention strategies to drive DSNP growth and optimize retention
• Provides training to local sales teams to drive sales, community lead generation and membership growth
• Provides input and direction into product design and bid strategy
• Participates in DSNP Network design, service area expansion, compliance audits, evaluation of network adequacy, development of provider reimbursement and education strategies/programs and provider performance, quality, and engagement
• Guides development and review of member facing materials
• Provide benefit education to the Care Team and offer support with member issues/trends to help improve member experience
• Help drive initiatives to improve member satisfaction and STARs
• Serves as subject matter expert regarding Medicaid policy for dual eligibles in assigned market including but not limited to eligibility, Medicaid programs and services, benefits, etc.
• Works collaboratively with Medicaid team to align on crossover work.
• Acts as trusted advisor and key resources for market related issues for Medicare corporate teams and local markets.
• Provides support to the Chief Duals Officer with the administration of integrated duals products
• Provides support to DSNP Market Leads in the region as needed
• 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: Mid Level