Medicare Sales Director

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🔥 0 minutes ago

🌵 Arizona – Remote

🌵 Arizona – Remote

💵 $105k - $231.1k / year

⏰ Full Time

🔴 Lead

🤑 Sales

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead day-to-day administration of D-SNP operations across Medicare and Medicaid functions • Ensure compliance with CMS, state (e.g., AHCCCS), and contractual requirements • Coordinate cross-functional teams including operations, marketing, enrollment, care management, compliance, and network • Oversee integrated processes such as enrollment, claims, grievances & appeals, and care coordination • Support D-SNP Model of Care execution, including care management and member engagement strategies • Monitor performance metrics (e.g., STAR ratings, quality, operational KPIs) and report to leadership • Identify and implement process improvements to enhance integration and member outcomes • Develop and implement comprehensive sales strategies to drive growth and member retention • Achieve and exceed enrollment targets • Analyze market trends, competitor activity, and regulatory changes to inform strategy • Identify and expand opportunities in key service areas • Build and execute local market growth plans • Optimize marketing channel mix including brokers, agents, telesales, and community development, and various marketing methodologies • Recruit, train, and coach new hires on product, regulatory (State and Federal), and compliance requirements • Educate and develop internal sales representatives • Ensure full and accurate communication of benefits and disclosure of restrictions are presented to each prospect, including provider and medication confirmations • Document oversight on all areas of the sales and retention process • Set performance expectations and monitor results • Ensure all sales activities adhere to CMS Marketing and Communication Guidelines • Maintain accurate documentation and reporting standards • Oversee Medicare sales call center operations, including inbound and outbound activity • Ensure call center performance meets KPIs such as call quality, compliance scores, and service levels • Partner with operations teams to optimize staffing models, scripting, training, and technology platforms • Drive continuous improvement in customer experience and sales effectiveness within the call center environment • Ensure successful CMS Call Center Monitoring Audit • Provide oversight of sales administration functions including reporting, forecasting, enrollment processing, and documentation • Ensure accurate tracking of sales metrics, commissions, and performance reporting • Establish and maintain standardized processes for sales operations and compliance documentation • Partner with internal teams to improve workflows, reduce errors, and enhance operational efficiency

🎯 Requirements

• Active health insurance license and AHIP certification REQUIRED • 5+ years of experience in Medicare Advantage, Medicaid, or managed care operations • Extensive knowledge of Medicare Advantage, AHCCCS, CMS regulations and D-SNP requirements • Strong cross-functional leadership and regulatory/compliance experience • Proven leadership experience managing sales team, call center, and community outreach • Demonstrated success achieving aggressive sales and retention targets • Data analysis and performance management capability • Ability to effectively communicate with executive level management.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs