Senior Manager, Medicare Product Operations; NCOD

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.

• 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.

• 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.

• 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.

• 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.

• Establishes and monitors key performance indicators (KPIs), operational dashboards, quality metrics, and service-level measures.
• Analyzes operational data to identify trends, root causes, risks, and opportunities for improvement.
• Presents operational performance updates, recommendations, and strategic insights to senior leadership.
• Utilizes data-driven decision-making to improve quality, efficiency, compliance, and member outcomes.

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