Senior Manager, Medicare Product Implementation

Senior Manager, Medicare Product Implementation

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.

As the Senior Manager, Medicare Product Implementation, you will lead the end-to-end implementation and operational execution of assigned Medicare Advantage programs in coordination with internal stakeholders and external provider and/or vendor partners. You will be responsible for gathering and analyzing requirements, developing implementation plans, ensuring programs are implemented accurately, delivered compliantly, and maintained/operationalized effectively to support both business objectives and member experience including resolving benefit and member issues, and continuously improving program performance.

Responsibilities Include:

• Act as a top-level specialist and lead end-to-end implementation and ongoing operations for assigned Medicare Advantage programs, ensuring successful implementation, readiness for annual go-live, successful year-over-year delivery, and program operational effectiveness.
• Develop, maintain, and manage key implementation deliverables, including project plans (establish timelines, identify milestones, track progress, identify risks, develop mitigation strategies, track performance metrics, and resource engagement), along with documentation of business and eligibility requirements, member journeys, operational workflows, and benefit crosswalks.
• Facilitate and lead regular project and implementation meetings to drive cross-functional execution across strategy, compliance, eligibility, claims configuration, member materials, provider contracting, and other internal and external partners providing updates and performance metrics to leadership and key stakeholders, addressing inquiries and resolving issues, and ensuring alignment, accountability, and timely delivery of project and program milestones.
• Partner closely with Provider Contracting and Value-Based Care teams to support the design, implementation, and ongoing management of programs tied to value-based provider arrangements, ensuring alignment between benefit intent, design, provider performance, member experience including benefit access while maintaining strong working relationships.
• Monitor program performance, member access, and utilization while identifying trends, root causes, and opportunities for improvement; identify and resolve operational issues related to eligibility, vendor processes, benefit configuration, and member experience.
• Ensure programs are implemented and operated in compliance with CMS regulations, filed benefit intent, and internal policies; support audits, attestations, and regulatory inquiries.
• Serve as the subject matter expert, make informed decisions and prioritize work across multiple programs and competing deadlines, providing input on operational feasibility, program design, and continuous improvement opportunities.
• Create and maintain a culture of collaboration and cross-functional teamwork, ensuring effective communication and coordination across departments and with leadership.
• Support bid-related activities including strategic discussions, benefit data entry, validation, change tracking, and quality assurance.
• Other duties as assigned.

Required Qualifications

• 7+ years of work experience with 5+ years working with Medicare Advantage including supplemental benefits and regulations.
• Experience leading complex cross-functional initiatives that include collaboration and teamwork.
• Experience with execution and delivery (planning, delivering, and supporting) including problem solving, decision making and communication (verbal and written) skills.
• Experience with project/program management including creating and maintaining project plans.
• Experience in a role that required you to be highly organized and detail oriented.
• Experience managing competing priorities in a matrixed environment.
• Proficiency with Microsoft Office and collaboration tools.

Preferred Qualifications

• Experience with CMS Flexibilities SSBCI and Uniformity Flexibility, or provider-based Medicare programs.
• Experience supporting audits or compliance reviews.
• Experience working with external value-based provider groups.

Education

• Bachelor's degree or equivalent experience required.

The typical pay range for this role is:

$67,900.00 - $182,549.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our 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.