Lead Director, DSNP Program Management

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Position Summary

As the Lead Director, DSNP Program Management you will support the General Manager in all aspects of the management and financial performance of the Special Needs plans which may include coordinated dual eligible plans (DSNP), chronic condition special needs plans (CSNP), and other related plans. In this role  you will be engaged in the development of products, monitor and analyze financial performance, support annual filings as well manage internal projects from initiation through completion.  You will secure required resources and use formal processes and tools to manage resources, budgets, risks and changes.

Fundament Job Components:

• Analyze product financial performance and drive improvements.
• Support developments of annual Bid development and annual filings associated with the products.
• Direct team members and collaborate with business partners throughout the development, implementation, and execution of the DSNP, CSNP and other similar plans.
• Manage projects to ensure on-time completion according to specifications and within budgeted costs.
• Apply advanced knowledge of the Medicare and Medicaid regulatory landscape to ensure program compliance with federal and state regulations governing DSNP programs.
• Serves as the liaison between Aetna and state regulators to assure State Medicaid Agency Contract execution is completed annually as required and that all contractual requirements are met
• Conduct advanced research on innovative healthcare delivery models that may enhance the impact of the programs.
• Evaluate the feasibility of integrated care models, care coordination strategies, and telehealth solutions for DSNP members.
• Consult on critical quality metrics for the program with stakeholders and implements evidence-based interventions to optimize program outcomes and improve member experiences.
• Develop methods for monitoring program expenditures and financial resources while maintaining program quality and compliance.
• Collaborates with healthcare providers, care managers, social workers, and other stakeholders to ensure integrated and coordinated care for dual eligible beneficiaries.
• Support and manage member and community engagement opportunities.
• Develop strategies for identifying and enrolling eligible individuals into the DSNP program and provides support to beneficiaries throughout the enrollment process.
• Coordinate the development and dissemination of educational materials and resources to beneficiaries to help them understand their benefits and access appropriate care.

 Required Qualifications

• 5 plus years of experience with Medicare and/or Medicaid programs in leadership roles
• Experienced and knowledgeable regarding Medicare, Medicaid and Duals regulations and programs
• Previous experience working cross-functionally within a highly matrixed health plan
• Experience in managing an operational function within a health plan
• 3 plus years developing effective strategies in designing an effective Duals program in an ever-changing regulatory environment
• Highly collaborative and experience presenting and communicating externally
• Excellent verbal and written communication skills

Preferred Qualifications

• Previous experience leading duals strategies preferred

Education

• Bachelor's degree or equivalent work experience

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,540.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.  This position also includes an award target in the company’s equity award program. 
 

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