Senior Manager, Integrated D-SNPs

CVS Health • Hartford, MI

4d • Hybrid

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. At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a Senior Manager, Integrated D-SNPs, you will play a critical role in supporting our Aetna members and our business by being a driving force within Aetna’s Medicare Organization’s National Duals Program Office which sets the strategy for the company’s Dual-Eligible Special Needs Plan (D-SNP) program and manages its Institutional Special Needs Plan (I-SNP) program and Special Needs Plan (SNP) training. As the Senior Manager of Integrated D-SNPs, you will focus on items pertaining to the integration of Medicare and Medicaid. You will have a dotted line to the National Duals Program Office’s Lead Director of Medicaid Policy and support projects from conception to execution and ongoing maintenance. You will also collaborate with the National Duals Program Office’s Special Needs Plan Trainer and serve as a subject matter expert for reviews of content focused on items such as: D-SNPs (Coordination-Only, Highly Integrated, and Fully Integrated), Applicable Integrated Plans, Lessor-Of payment methodologies, the Medicare Savings Program, etc. This role also includes partnering with internal Medicaid stakeholders on workgroups and other tasks focused internal Medicaid and Medicare alignment opportunities. You will also help identify and address opportunities for collaborations involving D-SNP and Medicaid and support execution of deliverables for a Duals Governance Committee. As Senior Manager of Integrated D-SNPs you will also support Aetna’s D-SNP Market Leads as they navigate nuances of Medicaid contracts and regulators for their assigned D-SNP states. You will also support the National Duals Program Office’s Senior Manager of D-SNP Operations in the development and maintenance of department policies and procedures and reviews of external vendors for services tailored towards dual-eligibles. Fundamental Job Components Keep abreast of regulatory policies and updates pertaining to D-SNPs and communicate those as appropriate to key internal partners. Serve as subject matter expert regarding highly integrated and fully integrated D-SNPs Understand and translate regulatory requirements to ensure D-SNP is compliant with state and CMS regulations Serve as National Duals Program Office SME for internal D-SNP and SNP implementation support / Assist with cross-functional work collaborations/model creation Support the review of contracts required for the course of business Develop playbooks, presentations, policies, and procedures Provide support to D-SNP Market Leads to help navigate Medicaid intricacies in their assigned D-SNP states Represent National Duals Program Office for Medicaid requests for proposals (RFPs) where D-SNP presence is requested Collaborate with Medicaid partners to identify, design, and implement integrated and aligned D-SNP solutions Attend Medicare Market bid meetings for insight into D-SNP changes and to communicate National strategies for alignment Support prompt turnaround of executive leadership requests by developing/delivering data, presentations, etc. Gather, synthesize, and present critical information in a concise format to facilitate efficient decision-making. This includes creating presentations for executive and senior-leadership audiences Operate effectively in ambiguous or evolving environments, exercising sound judgment to make appropriate, timely decisions. Work independently and consistently meet or exceed deliverables

Requirements

• 3+ years working with Medicare/D-SNP and/or Medicaid programs
• Experienced and knowledgeable regarding Medicare/D-SNP and Medicaid regulations and programs
• Previous experience working cross-functionally within a highly matrixed health plan or managed care organization
• Strong problem-solving and decision-making skills
• Excellent verbal and written communication and presentation skills

Nice To Haves

• We support a hybrid work environment. If selected and you live near a suitable work location, you may be expected to comply with the hybrid work policy. Under the policy, all hires for in-scope populations should be placed into a hybrid or office-based location, working onsite three days a week.

Responsibilities

• Keep abreast of regulatory policies and updates pertaining to D-SNPs and communicate those as appropriate to key internal partners.
• Serve as subject matter expert regarding highly integrated and fully integrated D-SNPs
• Understand and translate regulatory requirements to ensure D-SNP is compliant with state and CMS regulations
• Serve as National Duals Program Office SME for internal D-SNP and SNP implementation support / Assist with cross-functional work collaborations/model creation
• Support the review of contracts required for the course of business
• Develop playbooks, presentations, policies, and procedures
• Provide support to D-SNP Market Leads to help navigate Medicaid intricacies in their assigned D-SNP states
• Represent National Duals Program Office for Medicaid requests for proposals (RFPs) where D-SNP presence is requested
• Collaborate with Medicaid partners to identify, design, and implement integrated and aligned D-SNP solutions
• Attend Medicare Market bid meetings for insight into D-SNP changes and to communicate National strategies for alignment
• Support prompt turnaround of executive leadership requests by developing/delivering data, presentations, etc.
• Gather, synthesize, and present critical information in a concise format to facilitate efficient decision-making. This includes creating presentations for executive and senior-leadership audiences
• Operate effectively in ambiguous or evolving environments, exercising sound judgment to make appropriate, timely decisions.
• Work independently and consistently meet or exceed deliverables

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: Senior
• Number of Employees: 5,001-10,000 employees