Senior Manager, Medicare Product Operations (NCOD)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

The Senior Manager, Medicare Product Operations (NCOD) is responsible for providing leadership, operational oversight, and people management for the Non-Clinical Organization Determination (NCOD) team. This leader is accountable for ensuring accurate, timely, compliant, and member-centered coverage determinations while maintaining adherence to CMS regulations, and internal policies. The role oversees a team of managers and analysts responsible for evaluating member requests, issuing organization determinations, maintaining documentation, and supporting appeals- and grievance-related activities.

This position serves as a key operational leader, driving quality, compliance, performance, process optimization, workforce development, and cross-functional collaboration. The Senior Manager partners with Compliance, Product, Appeals, Grievances, Eligibility, Technology, and vendor partners to ensure operational excellence and a best-in-class member experience.

• Provides oversight for the NCOD operation, ensuring alignment with organizational goals, regulatory requirements, and member experience objectives.

• Establishes operational strategies, and performance standards that support long-term scalability and sustainability.

• Leads implementation of new NCOD workflows, benefit offerings, regulatory requirements, operational enhancements, and system improvements.

• Serves as a subject matter expert and operational consultant for NCODs.

• Oversees end-to-end NCOD operations, including intake, review, determination, documentation and communication.

• Ensures compliance with established turnaround times, and regulatory requirements.

• Monitors workload distribution, staffing needs, productivity trends, and inventory management.

• Leads operational readiness planning for benefit, process, policy, and technology changes.

• Directly supervises NCOD managers and analysts.

• Establishes clear performance expectations and accountability measures to drive individual and team success.

• Coaches, mentors, and develops staff through ongoing feedback, performance management, career development planning, and succession planning.

• Creates an inclusive, collaborative, and high-performing culture focused on accountability, quality, service, and continuous improvement.

• Leads workforce engagement initiatives and promotes a positive employee experience through recognition and development.

• Interviews, hires, develops talent, provides guidance and coaching, and foster a high-performance culture.

• Oversees ongoing training to ensure all team members are fully versed and compliant within their respective roles.

• Ensures adherence to CMS regulations, internal policies, audit standards, and organizational determination guidelines.

• Oversees and participates in quality assurance programs, audit activities, and calibration initiatives.

• Maintains oversight of documentation standards to ensure decisions are accurate, complete, defensible, and audit-ready.

• Partners with Compliance and Operational Integrity teams to assess regulatory changes and implement operational impacts.

• Identifies and mitigates operational, compliance, and regulatory risks.

• Establishes and monitors key performance indicators (KPIs), operational dashboards, quality metrics, and service-level measures.

• Analyzes operational data to identify trends, root causes, risks, and opportunities for improvement.

• Presents operational performance updates, recommendations, and strategic insights to senior leadership.

• Utilizes data-driven decision-making to improve quality, efficiency, compliance, and member outcomes.

• Leads continuous improvement initiatives focused on operational efficiency, quality outcomes, member satisfaction, and regulatory compliance.

• Develops and enhances workflows, standard operating procedures, training materials, and operational controls.

• Identifies workflow optimization strategies, and technology enhancements.

• Partners with Product, Compliance, Appeals, Grievances, Eligibility, Technology, Vendor Management, customer service, and other stakeholders to resolve issues and improve performance.

• Builds strong partnerships across the organization to ensure alignment and successful execution of strategic initiatives.

• Supports enterprise projects, implementations, audits, and regulatory readiness activities.

• 7+ years of Medicare Advantage, healthcare operations, compliance, appeals, grievances, organization determinations, supplemental benefits, claims, or related experience.

• 3+ years of leadership experience managing teams.  

• Strong knowledge of Medicare Advantage regulations, CMS guidance, organization determinations, appeals, grievances, and supplemental benefit administration.

• Experience translating regulation requirements into operational processes and controls.

• Advanced organizational and prioritization skills with the ability to manage multiple competing priorities.

• Proficiency in Microsoft Office Suite and operational reporting tools.

• Master’s degree in Business, Healthcare Administration, Public Health, Operations, or related field.

• Experience leading Medicare Advantage organization determination, appeals, compliance, or supplemental benefit operations.

• Experience supporting audits, regulatory examinations, or corrective action programs.

• Bachelor’s Degree or equivalent experience.

The typical pay range for this role is: