Special Needs Plans Operations Manager

This is a fully remote position, open to applicants in United States.

📋 Description

• Annually develop Devoted's Models of Care (MOCs) in partnership with the SNP Operations Director.

• Manage and oversee Devoted's policies, procedures, and compliance frameworks, ensuring adherence to CMS and Model of Care requirements, while maintaining readiness for audits.

• Analyze new or updated Model of Care and CMS requirements, collaborating cross-functionally to create and execute operational solutions.

• Design and implement improved processes to ensure compliance with Model of Care and CMS-related SNP requirements, including the establishment of early warning systems to identify and mitigate potential gaps.

• Cultivate subject matter expertise in Medicaid benefits, developing knowledge resources and configurations that assist frontline staff and members in navigating and coordinating Medicare and Medicaid benefits.

• Supervise routine Medicaid reporting alongside the SNP Operations Director and other SNP Managers, while working cross-functionally to accurately and promptly develop and submit necessary Medicaid reports.

• Provide additional compliance and operational assistance across SNP and Medicaid programs as needed.

⛳️ Requirements

• Minimum of 3 years of experience in Medicare Advantage, Managed Care, Health Plan, or healthcare operations.

• Demonstrated ability to interpret CMS and/or State Medicaid regulatory guidelines and convert them into standardized operational workflows and compliance processes.

• Detail-oriented, dependable, independent, and inquisitive, with a proven history of managing compliance tasks in a dynamic environment.

• Excellent communication skills with a proven ability to collaborate with and influence cross-functional teams.

• Preferred experience with Special Needs Plans (SNPs), SNP Model of Care (MOC) development and implementation, or SNP care management operations.

• Preferred experience in the Medicaid arena, including Medicaid compliance, benefits administration, claims processing, or D-SNP dual-eligible benefit coordination.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.

• Generous paid time off.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all positions, excluding those at the Director level and above.

• Parental leave program.

• 401K program.