Manager, Medicare Network Operations

Company: Nurses Co
Location: Seattle
Posted on: November 19, 2023

Job Description:

Job DescriptionWe are looking for a self-starter with exceptional customer service skills with excellent interpersonal skills and a keen attention to detail. This person is creative but metrics-driven individual with an understanding of relationship building and strong analytical skills.* Ensures that provider questions related to Aetna patients are promptly resolved while maintaining the highest level of customer service* Monitor and manage weekly member auto-assignments to confirm or correct accuracy of members physician alignment * Work closely with provider marketing and markets sales director on co-branding/co-marketing opportunities and effectiveness of campaigns* Foster relationships along with network partners with our value-based provider partners* Market CTM/Grievance trend analysis * Provides support for the Medicare 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.* Serves as subject matter expert for the operational functions of Medicare products within an assigned market.* Assists with the execution of all CMS and state-specific required activities and processes including the accuracy and compliance of the annual bid application, state-specific compliance, 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.* Support of ad-hoc operations excellence projectsPay 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 Qualifications- Minimum of three years in healthcare- Strong work ethic and commitment to service excellence- Ability to work both independently in the field and within a larger team- Superior sales and customer service skills- Proven track record of successful relationship building and ability to meet productivity targets- Strong attention to detail, excellent judgement, communication, and organizational skills- Self-starter- Strong analytical skillsCOVID 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 Qualifications- Previous customer or account management experience working with physicians - Mastery skills in Microsoft applications in PowerPoint, Excel, and Word- Health and Life LicenseEducationBachelors degree or equivalent work experience (HS diploma + 4 years relevant experience)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.
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Keywords: Nurses Co, Seattle , Manager, Medicare Network Operations, Executive , Seattle, Washington