Govt Programs Ops Cnslt

Job Description
Serves as subject matter expert for the implementation of all Medicare Part D and Medicare Advantage activities and programs across a market in support of the General Manager. Provides guidance and consultation for new product start-up, program design and regulatory compliance. Provides support for the Medicare Part D and Medicare Advantage operational interface to ensure tactical business goals are achieved across the organization. Supports the CMS bid and application activities.

Required Qualifications
• Serves as subject matter expert for the operational functions of Medicare products within an assigned market.
• Assists with the execution of all CMS required activities and processes including the accuracy and compliance of the annual bid application, expansion application, member materials, and group setup.
• Supports internal and external Medicare audit activity including CMS and operation integrity audits. Coordinates file pulls, data requests, universe development, and supporting documentation.
• Maintains an awareness of trends, developments, and governmental regulations in Medicare and managed health care organizations.
• Provides consultative support for Medicare product design features, integration schedule, and operational readiness in a new product start-up environment.
• May participate on various committees to represent the Medicare Department including NCQA, Internal Research, UM/QI, Trend/MER, Risk Mitigation, Complaint and Appeals, bid, implementation, and migration.
• Supports 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 issues.
• Monitors sales and marketing activities to assure adherence to Federal and State regulations.
• Performs other related duties as assigned.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions 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, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are 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 within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
• Previous experience (5-7 years) in Medicare Operations and/or Medicare compliance function
• Familiarity with regulations and statutes impacting the managed care environment.
• Ability to perform analysis and legal research to identify and clarify issues.
• Excellent consulting and leadership skills.
• Excellent communication, interpersonal and presentation skills.
• Able to effectively coordinate multiple projects and programs in a matrix environment and work independently.
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

Education
Bachelor's degree desired or equivalent work experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.