Senior Manager, Medicaid Operations

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.

Job Description Summary

Provides oversight of strategies to monitor quality and performance metrics, resolving escalated provider issues, and collaborating with other departments to enhance the overall customer experience. Applies leadership skills, customer-centric mindset, and problem-solving abilities to drive customer loyalty, retention, and advocacy while promoting a positive and service-oriented culture within the organization.

Job Description

• Collaborates with local health plan and national team to streamline service processes and improve operational efficiency.

• Ensures that systems are configured appropriately to allow proper claims payment and provider reimbursement.

• Collaborates with multiple departments to identify root cause of claims payment issues and submits configuration updates to address system setup issues.

• Prepares and monitors reporting for operational trends related to credentialing, provider network adequacy, provider reimbursement.

• Optimizes service operations and enhance customer support efforts through innovative technologies and systems.

• Monitors key performance indicators (KPIs) to measure service performance, ensuring that the services provided meet the established quality standards and customer expectations.

• Fosters a customer-centric culture, emphasizing empathy, effective communication, and problem-solving skills in all customer interactions.

• Focuses on customer and provider satisfaction by monitoring feedback, addressing complaints, implementing measures to enhance the customer experience, and preparing responses to the state regulator

• Communicates strategically with IT and data management teams, leveraging technology and data analytics to optimize service operations, improve efficiency, and enhance customer insights.

Education

Bachelors degree preferred

Pay Range

The typical pay range for this role is:

$67,900.00 – $149,328.00

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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/13/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. 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.