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Job Description
Job Description
The National DSNP Program Office supports Dual Special Needs Plans (DSNP) growth, expansion, strategy, clinical and administrative operations for all DSNPs offered by Aetna. The primary goal of the Manager, Medicaid Eligibility and Program Policy is to ensure that all areas supporting DSNP products have the information needed to effectively meet member needs and their operational requirements. The Manager, Medicaid Eligibility and Program Policy, will be responsible for documenting and developing a detailed understanding of Medicaid eligibility and policy for dual eligibles including Medicaid programs, payment structures and processes, and delivery systems in all states in which we operate or plan to operate a DSNP. They will work with internal stakeholders to develop resource, education and training materials with state-specific details regarding eligibility for various Medicaid programs, how individuals apply for Medicaid and specific managed care or waivered services, how services are provided, covered benefits and services, etc. Stakeholders will include but are not limited to DSNP care management, customer service, marketing and sales, product, operations integrity, market-based resources, etc.
Required Qualifications
Experience with and knowledge of Medicaid programs, services, and eligibility at the federal and state levels including dual eligibles
Experience with Dual Special Needs Plans
5+ years related cross-functional, project management experience.
Preferred Qualifications
Experience with Medicaid managed care
Experience with Medicare and Medicaid integrated managed care plans
Education
BA or equivalent; typically advanced degree
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
The National DSNP Program Office supports Dual Special Needs Plans (DSNP) growth, expansion, strategy, clinical and administrative operations for all DSNPs offered by Aetna. The primary goal of the Manager, Medicaid Eligibility and Program Policy is to ensure that all areas supporting DSNP products have the information needed to effectively meet member needs and their operational requirements. The Manager, Medicaid Eligibility and Program Policy, will be responsible for documenting and developing a detailed understanding of Medicaid eligibility and policy for dual eligibles including Medicaid programs, payment structures and processes, and delivery systems in all states in which we operate or plan to operate a DSNP. They will work with internal stakeholders to develop resource, education and training materials with state-specific details regarding eligibility for various Medicaid programs, how individuals apply for Medicaid and specific managed care or waivered services, how services are provided, covered benefits and services, etc. Stakeholders will include but are not limited to DSNP care management, customer service, marketing and sales, product, operations integrity, market-based resources, etc.
Required Qualifications
Experience with and knowledge of Medicaid programs, services, and eligibility at the federal and state levels including dual eligibles
Experience with Dual Special Needs Plans
5+ years related cross-functional, project management experience.
Preferred Qualifications
Experience with Medicaid managed care
Experience with Medicare and Medicaid integrated managed care plans
Education
BA or equivalent; typically advanced degree
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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