Santa Ana, California

Job Description
This position reports to the CA Medicare Director of Operations and will work with key business partners to evaluate, document, and implement business requirements specific to the California Market.
Serves as a subject matter expert on Medicare operations and business process improvement in a capitated HMO structured model where health plan functions are delegated to contracted Medical Groups.
In this role, candidate will partner with functional areas to conduct an end-to-end assessment of the member experience to define requirements, identify and document gaps in processes, identify key stakeholders, solutions, and prioritization for resolution.

This individual will be responsible to lead and implement operational system enhancements and process improvements to ensure that requirements are built into multiple Aetna business platforms including but not limited to enrollment, sales, provider search, customer support, claims processing, etc to close gaps and ensure alignment between Aetna and our contracted Medical Groups.
Candidate will be accountable for owning critical projects and driving them to completion to promote operational excellence and improve metrics related to member and provider experience. Individual will also maintain operational reporting and conduct monthly capitation audits. Candidate must be resourceful and creative to navigate through multiple departments and operate strategically to improve system functions and able to implement and track multiple projects from end to end.

Pay Range
The typical pay range for this role is:
Minimum: 75,400
Maximum: 158,300

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
- 5+ years’ experience in Medicare product and/or health plan operations, or managed care programs.
- 3+ years’ experience in implementation and process improvement projects
- 3+ years’ experience in California delegated network model

0-10% travel may be required
Hybrid Work Model- 2 days in office;3 Days Remote

- Excellent interpersonal, analytical, problem-solving, organizational, issue resolution, and customer relationship management skills
- Understanding of system process flows
- Excellent verbal and written communication skills
- A collaborative project manager, accountable for the overall execution of multiple key projects and driving them to completion
- A problem solver with experience with validating business requirements, generating key insights, performing test case scenarios, and monitoring internal processes to ensure consistency
- Establishing multiple operational reports
- High-level of attention to detail and accuracy
- Team player
- Proficiency in Microsoft Office (Word, Excel, PowerPoint).

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
- MS Excel – Advanced
- Tableau – Advanced
- Lean Six Sigma Certification
- Process Flow Management
- Advanced analytical skills
- 3-5+ years’ experience in project managing/reporting/system
- Healthcare background with knowledge of the CA Market health care delivery system, Delegated Network Models, Medicare Advantage, Managed Care, Medicare operations, Medicare Stars, Member Experience KPIs

MBA, Business Administration or equivalent work experience

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. See Job Description

Santa Ana, California

Continue serving and work with a purpose

As a CVS Health colleague, you'll find career opportunities across the organization and at every stage of your career. More important, your work will have an impactful purpose on someone's life, including your own. Learn more about how you can continue serving on your next mission at CVS Health.

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