The Senior Manager, Medicare Product Operations (NCOD) leads the Non-Clinical Organization Determination (NCOD) team at CVS Health, providing operational oversight and people management to support accurate, timely, and compliant organization determinations. The role focuses on quality, performance, process optimization, workforce development, and cross-functional execution.
Role Overview
In this onsite role in Hartford, CT, you will provide leadership for NCOD operations and ensure alignment with organizational goals, regulatory requirements, and member experience objectives. You will also serve as a subject matter expert and operational consultant for organization determinations, driving end-to-end execution from intake through documentation and communication.
Key Responsibilities
- Provide oversight for NCOD operations to ensure alignment with organizational goals, regulatory requirements, and member experience objectives.
- Develop operational strategies and performance standards that support long-term scalability and sustainability.
- Lead implementation of new NCOD workflows, benefit offerings, regulatory requirements, operational enhancements, and system improvements.
- Oversee end-to-end NCOD operations, including intake, review, determination, documentation, and communication.
- Ensure compliance with established turnaround times and regulatory requirements.
- Monitor workload distribution, staffing needs, productivity trends, and inventory management.
- Lead operational readiness planning for changes across benefits, processes, policies, and technology.
- Directly supervise NCOD managers and analysts, setting performance expectations and accountability measures.
- Coach and develop staff through feedback, performance management, career development planning, and succession planning.
- Create an inclusive, collaborative, high-performing culture centered on accountability, quality, service, and continuous improvement.
- Lead workforce engagement initiatives and promote a positive employee experience through recognition and development.
- Oversee interviews, hiring, and talent development to build and maintain a high-performance culture.
- Ensure ongoing training so team members remain fully versed and compliant within their roles.
- Ensure adherence to CMS regulations, internal policies, audit standards, and organizational determination guidelines.
- Oversee and participate in quality assurance programs, audit activities, and calibration initiatives.
- Maintain documentation standards to ensure decisions are accurate, complete, defensible, and audit-ready.
- Partner with Compliance and Operational Integrity teams to assess regulatory changes and implement operational impacts.
- Identify and mitigate operational, compliance, and regulatory risks.
- Establish and monitor KPIs, operational dashboards, quality metrics, and service-level measures.
- Analyze operational data to identify trends, root causes, risks, and opportunities for improvement.
- Present operational performance updates, recommendations, and strategic insights to senior leadership.
- Drive continuous improvement initiatives focused on operational efficiency, quality outcomes, member satisfaction, and regulatory compliance.
- Develop and enhance workflows, standard operating procedures, training materials, and operational controls.
- Identify workflow optimization strategies and technology enhancements.
- Partner with Product, Compliance, Appeals, Grievances, Eligibility, Technology, Vendor Management, customer service, and other stakeholders to resolve issues and improve performance.
- Support enterprise projects, implementations, audits, and regulatory readiness activities.
Required Qualifications
- 7+ years of Medicare Advantage, healthcare operations, compliance, appeals, grievances, organization determinations, supplemental benefits, claims, or related experience.
- 3+ years of leadership experience managing teams.
- Strong knowledge of Medicare Advantage regulations, CMS guidance, organization determinations, appeals, grievances, and supplemental benefit administration.
- Experience translating regulation requirements into operational processes and controls.
- Advanced organizational and prioritization skills with the ability to manage multiple competing priorities.
- Proficiency in Microsoft Office Suite and operational reporting tools.
- Bachelor’s Degree or equivalent experience.
Preferred Qualifications
- Master’s degree in Business, Healthcare Administration, Public Health, Operations, or related field.
- Experience leading Medicare Advantage organization determination, appeals, compliance, or supplemental benefit operations.
- Experience supporting audits, regulatory examinations, or corrective action programs.
Technologies
Compensation and Incentives
The typical pay range for this role is USD 75,400 - 182,549 per year. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range. The role also includes an award target in the company’s equity award program.
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources
Application Details
Application window closing date: 10/10/2026
Equal Opportunity and Record Consideration
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
