Special Needs Plans (SNP) Operations Manager

Devoted Health•Waltham, MA

12d•$73,000 - $130,000•Remote

About The Position

You will join our SNP Operations team, a collaborative team dedicated to building high-performing, compliant operational systems that ensure Devoted’s Special Needs Plans consistently meet rigorous CMS and Medicaid standards. In this role, you will oversee day-to-day regulatory requirements, manage compliance documentation, and handle operational due diligence across our SNP programs. You’ll also drive key process improvements and standardization, ensuring our SNP operations and reporting run smoothly, accurately, and without gaps. Finally, as CMS and Medicaid standards change, you will blend regulatory compliance with operational strategy—translating changing CMS and Medicaid requirements into seamless workflows that empower our frontline teams to deliver exceptional care to our SNP members.

Requirements

3+ years of experience in Medicare Advantage, Managed Care, Health Plan, or health care operations.
Proven ability to interpret CMS and/or State Medicaid regulatory guidelines and translate them into standard operational workflows and compliance processes.
Highly detail-oriented, reliable, independent, and curious, with a track record of managing detailed compliance tasks in a fast-paced environment.
Strong communication skills with a demonstrated ability to collaborate with and influence cross-functional teams.

Nice To Haves

Direct experience with Special Needs Plans (SNPs), SNP Model of Care (MOC) development and implementation, or SNP care management operations.
Experience in the Medicaid space (e.g., Medicaid compliance, benefits administration, claims processing, or D-SNP dual-eligible benefit coordination).

Responsibilities

Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director.
Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness.
Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions.
Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps.
Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits.
Oversee, with the SNP Operations Director and other SNP Managers, routine Medicaid reporting, and work cross-functionally to develop and submit required Medicaid reports accurately and timely.
Provide additional compliance and operational support across SNP and Medicaid programs as assigned.