Senior Manager, Medicare Product Operations (NCOD)
Core
Provide leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team to ensure accurate, timely, compliant, and member-centered coverage determinations.
Role type
Senior Manager, Medicare Product Operations
Builds
Operational strategies, workflows, and performance standards for Medicare Advantage organization determinations
Domain
Healthcare / Medicare Advantage / Regulatory Compliance
Required skills
Medicare Advantage operations, CMS regulations, appeals and grievances management, team leadership, process optimization, compliance oversight, data analytics, stakeholder collaboration
Preferred skills
Master's degree in Business/Healthcare, audit support experience, corrective action program experience
Technologies
Microsoft Office Suite, operational reporting tools
Responsibilities
Establish operational strategies and performance standards; oversee end-to-end NCOD operations including intake, review, and determination; supervise managers and analysts; ensure adherence to CMS regulations and internal policies; monitor KPIs and operational dashboards; lead continuous improvement initiatives; partner with Compliance, Product, and Technology teams.
Seniority
Senior, hands-on IC with people management
