Manager, Medicare Network Operations
Company: Nurses Co
Location: Seattle
Posted on: November 19, 2023
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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
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