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.

• Strategic Leadership 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.
• Operational Management 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.
• People Leadership 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.
• Compliance and Quality Oversight 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.
• Performance Management and Analytics…