Special Needs Plans Operations Manager

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $73k - $130k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director • Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness • Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions • Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps • Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits • Oversee routine Medicaid reporting with the SNP Operations Director and other SNP Managers, and work cross-functionally to develop and submit required Medicaid reports accurately and timely • Provide additional compliance and operational support across SNP and Medicaid programs as assigned

🎯 Requirements

• 3+ years of experience in Medicare Advantage, Managed Care, Health Plan, or health care operations • Proven ability to interpret CMS and/or State Medicaid regulatory guidelines and translate them into standard operational workflows and compliance processes • Highly detail-oriented, reliable, independent, and curious, with a track record of managing detailed compliance tasks in a fast-paced environment • Strong communication skills with a demonstrated ability to collaborate with and influence cross-functional teams • Direct experience with Special Needs Plans (SNPs), SNP Model of Care (MOC) development and implementation, or SNP care management operations preferred • Experience in the Medicaid space, such as Medicaid compliance, benefits administration, claims processing, or D-SNP dual-eligible benefit coordination preferred

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Parental leave program • 401K program