Job Title

Job DescriptionIn this role you will serve as a as subject matter expert for the implementation of all Medicare and/or Medicaid health care activities and programs in the New York market in support of the General Manager. To do this your responsibilities will include but not be limited to the below:Provides guidance and consultation for newproduct start"up, program design and regulatory compliance. Provides support for the Medicare and/or Medicaid health care operational interface to ensure tactical business goals are achieved across the organization.Supports the CMS bid and application activities and state"level request for proposal activities.Supports internal and external Medicare and/or Medicaid audit activity including CMS and operation integrity auditscoordinates file pulls, data requests, universe development, and supporting documentationProvides consultative support for Medicare and/or Medicaid product design features, integration schedule, and operational readiness in a new product start-up environmentMay participate on various committees to represent the Medicare and/or Medicaid Departments including NCQA, Internal Research, UM/QI, Trend/MER, Risk Mitigation, Complaint and Appeals, bid, request for proposals, implementation and migrationSupports member retention activities, including development of outreach materials, design/implementation of outreach programs both directly and in coordination with corporate member retention team, development of talking points/educational pieces about market specific issuesAssists the Medicare Director of Operations in developing market-based risk adjustment strategies and driving execution of critical revenue related activities for medical record retrievals by working collaboratively with Network and Risk Adjustment department.Pay RangeThe typical pay range for this role is:Minimum: 60,300Maximum: 126,600Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsFive years experience in Medicare or equivalent managed care operations. Proven knowledge and expertise of Medicare member experience and claims. Subject matter expert in regulations and statues impacting the Medicare business.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications7 years in Medicare/Medicaid OperationsProject management skillsConsulting and leadership skillsPerform analysis and legal researchExcellent communication, interpersonal and presentation skillsProficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPointEducationAssociates degree or 7 years of relevant experience within managed care.Business OverviewBring your heart to CVS HealthEvery 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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.