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.Position Summary

In support of the Chief Medicare Officer, the candidate has responsibility for ensuring that the local Medicare business is compliantly and effectively operating in the market. As such, the Lead Director of Medicare Operations supports MAPD and SNP initiatives and implements and oversees activities and programs across the market to achieve earnings and growth objectives.Position Duties & Responsibilities

• Directs operational functions of Medicare products across a market as directed by the Chief Medicare Officer.
• Drives successful market results by improving provider and vendor performance, as well as implementing tactics to address emerging claims experience.
• Responsible for AEP operational readiness including the education and training of Sales team, telesales, and customer service teams.
• Provides operational support for market management of plans, members, network providers, and distribution partners.
• Serves in a strategic capacity overseeing value based provider contracting and performance.
• Serves in a strategic capacity in the bid process as it relates to product and benefit design, competitive analysis, membership modeling, and Contract/PBP strategy.
• In partnership with the Product organization, responsible for the oversight and execution, at the local market level, of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, group set up. Uses competitive intelligence to guide, consult and drive product implementation and strategic focus for Medicare Part D and Medicare Advantage.
• Develops Sales & Membership model in conjunction with Chief Medicare Officer, Sales Center of Excellence, and Enterprise; accountable to ensure that all customer and broker facing material is accurate and compliant.
• Manages member retention activities, including development of outreach material, design/implementation of outreach programs both directly and in coordination with corporate member retention team, development of talking points/educational pieces about market specific issues.
• Develops and implements business strategies to provide accurate and proactive customer service to members, plan sponsors, and brokers.
• In partnership with Operations Integrity and at the direction of the Chief Medicare Officer, may facilitate internal and external Medicare audit activity including CMS and operations integrity audits. Coordinates file pulls, data requests, universe development and supporting documentation.

• 7 years' experience in Medicare or equivalent managed care operational and technical skills.
• Subject matter expert in regulations and statutes impacting the Medicare business.
• Ability to perform analysis and legal research to identify and clarify issues.
• Business acumen and experience with managing complex processes.
• Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook).
• Excellent written and verbal communication and presentation skills.

• Bachelors' degree or equivalent experience