Job DescriptionA bit about this role:You will join our SNP Operations team, a collaborative team dedicated to building high-performing, compliant operational systems that ensure Devoted's Special Needs Plans consistently meet rigorous CMS and Medicaid standards.
In this role, you will oversee day-to-day regulatory requirements, manage compliance documentation, and handle operational due diligence across our SNP programs. You'll also drive key process improvements and standardization, ensuring our SNP operations and reporting run smoothly, accurately, and without gaps. Finally, as CMS and Medicaid standards change, you will blend regulatory compliance with operational strategy-translating changing CMS and Medicaid requirements into seamless workflows that empower our frontline teams to deliver exceptional care to our SNP members.
Your Responsibilities and Impact will include:- Develop Devoted's Models of Care (MOCs) annually in collaboration with the SNP Operations Director.
- Oversee and manage Devoted's policies, procedures, and compliance universes in compliance with CMS and Model of Care requirements, ensuring perpetual audit-readiness.
- Review new or changing Model of Care and CMS requirements, working cross-functionally to develop and implement operational solutions.
- Develop and implement enhanced processes to oversee compliance with Model of Care and CMS-related SNP requirements, including building early warning systems to detect and prevent potential gaps.
- Develop Medicaid benefit subject matter expertise, creating knowledge tools and configurations that support frontline staff and members in understanding and coordinating Medicare and Medicaid benefits.
- Oversee, with the SNP Operations Director and other SNP Managers, routine Medicaid reporting, and work cross-functionally to develop and submit required Medicaid reports accurately and timely.
- Provide additional compliance and operational support across SNP and Medicaid programs as assigned.
Required skills and experience:- 3+ years of experience in Medicare Advantage, Managed Care, Health Plan, or health care operations.
- Proven ability to interpret CMS and/or State Medicaid regulatory guidelines and translate them into standard operational workflows and compliance processes.
- Highly detail-oriented, reliable, independent, and curious, with a track record of managing detailed compliance tasks in a fast-paced environment.
- Strong communication skills with a demonstrated ability to collaborate with and influence cross-functional teams.
Desired skills and experience:- Direct experience with Special Needs Plans (SNPs), SNP Model of Care (MOC) development and implementation, or SNP care management operations.
- Experience in the Medicaid space (e.g., Medicaid compliance, benefits administration, claims processing, or D-SNP dual-eligible benefit coordination).
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Salary Range: $73,000 - $130,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
- Parental leave program
- 401K program
- And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
