Position SummaryAs an Operations Manager - Medicare, you will serve as a leader of leaders within the Medicare Prior Authorization and Coverage Determinations Department. You will be directly accountable for the sustained performance and development of a team of Supervisors, Pharmacists, and representatives - ensuring operational, financial, compliance, and service excellence across phone and fax operations.
This role requires more than day-to-day execution. You will own systemic and recurring performance patterns across your teams, set non-negotiable standards for supervisor execution, and drive accountability through coaching, inspection, and evidence-based follow-through. You will partner with your Sr. Manager to deliver results that are 100% compliant with Medicare regulations.
This is a work-from-home opportunity from any location within the United States.
You will be responsible for:- Leading and developing supervisors as leaders - coaching them to manage performance, hold accountability, and develop their own teams
- Owning team performance outcomes including productivity, quality, attendance, service levels, and CMS-mandated turnaround times across multiple teams
- Identifying and addressing systemic performance patterns - not just reacting to individual misses, but inspecting recurring trends and driving sustainable improvement
- Partnering on client operations - supporting new and existing client implementations in collaboration with account services and cross-functional partners
- Leading workforce and workflow management - ensuring staffing, scheduling, and operational readiness to meet volume demands and financial targets
- Maintaining regulatory and audit readiness - ensuring all processes, documentation, and team practices align with Medicare Part D and Part B requirements
- Sourcing, interviewing, and hiring top talent in partnership with recruitment and business partners
- Leading daily operations and leadership calls - providing clear, executive-ready communication on team status, risks, and action plans
- Creating and maintaining standard operating procedures that reflect current work instructions and support consistent, compliant execution
- Managing to budget - aligning resources, staffing, and operational decisions to financial expectations
- Driving change management and continuous improvement - supporting implementations, process changes, and operational initiatives with a focus on sustainable results
Required Qualifications- 3+ years of experience with healthcare regulatory programs (Medicare, Medicaid, or Dedicated Client), including familiarity with CMS turnaround time requirements and audit standards
- 3+ years of direct people leadership experience, including managing frontline supervisors or individual contributors
- Experience managing in a metric-driven production environment (e.g., service levels, turnaround times, quality scores)
Preferred Qualifications- Resource Planning experience is highly desirable
- Experience navigating cross-functional partnerships to resolve operational or client issues
- Experience leading teams through operational transitions, process changes, or system implementations
- Ability to manage up effectively - proactively communicating risks, status, and recommendations to senior leadership
- Demonstrated ability to communicate clearly with frontline teams and senior leaders alike
- Project Management experience
- Experience coaching and developing frontline leaders, including performance management and talent development
EducationBachelor's Degree or equivalent work experience
Anticipated Weekly Hours40
Time TypeFull time
Pay RangeThe typical pay range for this role is:
$60,300.00 - $132,600.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Great benefits for great peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 07/23/2026
