Senior Manager, Medicare Product Operations (NCOD)

The Senior Manager, Medicare Product Operations (NCOD) leads the Non-Clinical Organization Determination (NCOD) team, overseeing operational execution and people leadership to deliver accurate, timely, compliant, and member-centered coverage determinations.

Role Overview

This position provides operational oversight, quality and compliance management, and team development for NCOD determinations. The role ensures adherence to applicable requirements, drives process optimization, monitors performance using KPIs and dashboards, and partners across functions to improve outcomes for members.

Key Responsibilities

• Provide oversight of NCOD operations to maintain alignment with organizational goals, regulatory requirements, and member experience objectives.
• Define 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.
• Act as a subject matter expert and operational consultant for organization determinations.
• 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 benefit, process, policy, and technology changes.
• Directly supervise NCOD managers and analysts, establishing clear performance expectations and accountability measures.
• Coach, mentor, and develop staff through feedback, performance management, career development planning, and succession planning.
• Create an inclusive, collaborative, high-performing culture focused on accountability, quality, service, and continuous improvement.
• Support workforce engagement and promote a positive employee experience through recognition and development.
• Interview, hire, develop talent, provide guidance and coaching, and foster a high-performance culture.
• Oversee ongoing training to ensure team members are fully versed and compliant within their roles.
• Ensure adherence to CMS regulations, internal policies, audit standards, and organizational determination guidelines.
• Oversee quality assurance programs, audit activities, and calibration initiatives.
• Maintain oversight of 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 improvement opportunities.
• 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 ability to manage multiple competing priorities.
• Proficiency in Microsoft Office Suite and operational reporting tools.

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.

Education

Bachelor’s Degree or equivalent experience.

Location and Work Setting

Scottsdale, AZ (onsite).

Compensation

The typical pay range for this role is $75,400.00 - $182,549.00 per year.

Technology

• Microsoft Office Suite

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• CVS Health bonus, commission or short-term incentive program
• Award target in the company’s equity award program