Lead Director of Medicare Sales - Northern California

Company: CVS Pharmacy
Location: Sacramento
Posted on: January 26, 2023

Job Description:

Search by job title, category, or Military MOS code Lead Director of Medicare Sales - Northern CaliforniaJob Description
**Qualified candidates will be in the Northern CA market**

This position reports to the CA Medicare Chief Medicare Officer and will work with key business partners to evaluate, document, and implement business requirements specific to the California Market.
Serves as a subject matter expert on Medicare operations and business process improvement in a capitated HMO structured model where health plan functions are delegated to contracted Medical Groups.
In this role, candidate will partner with functional areas to conduct an end-to-end assessment of the member experience to define requirements, identify and document gaps in processes, identify key stakeholders, solutions, and prioritization for resolution.

This individual will be responsible to lead and implement operational system enhancements and process improvements to ensure that requirements are built into multiple Aetna business platforms including but not limited to enrollment, sales, provider search, customer support, claims processing, etc. to close gaps and ensure alignment between Aetna and our contracted Medical Groups.
Candidate will be accountable for owning critical projects and driving them to completion to promote operational excellence and improve metrics related to member and provider experience. Individual will also maintain operational reporting and conduct monthly capitation audits. Candidate must be resourceful and creative to navigate through multiple departments and operate strategically to improve system functions and able to implement and track multiple projects from end to end.Pay Range
The typical pay range for this role is:
Minimum: 105,000
Maximum: 226,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications
- 5+ years' experience in Medicare product and/or health plan operations, or managed care programs.
- 3+ years' experience in implementation and process improvement projects.
- 3+ years' experience in California delegated network model.
- 0-10% travel may be requiredPreferred Qualifications
- MS Excel - Advanced
- Tableau - Advanced
- Lean Six Sigma Certification
- Process Flow Management
- Advanced analytical skills
- 3-5+ years' experience in project managing/reporting/system
- Healthcare background with knowledge of the CA Market health care delivery system, Delegated Network Models, Medicare Advantage, Managed Care, Medicare operations, Medicare Stars, Member Experience KPIs
- Hybrid Work Model- 2 days in office; 3 Days Remote is an option.Education
MBA, Business Administration or equivalent work experience.Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors--- support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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