Note: The job is a remote job and is open to candidates in USA. CVS Health is a company dedicated to improving health outcomes and providing a compassionate health experience. The Medicare Sales Director will oversee the operational and regulatory execution of the Medicare Advantage Dual Eligible Special Needs Plan, ensuring compliance and driving growth while managing sales teams and optimizing market development.
Responsibilities
- Lead day-to-day administration of D-SNP operations across Medicare and Medicaid functions
- Ensure compliance with CMS, state (e.g., AHCCCS), and contractual requirements
- Coordinate cross-functional teams including operations, marketing, enrollment, care management, compliance, and network
- Oversee integrated processes such as enrollment, claims, grievances & appeals, and care coordination
- Support D-SNP Model of Care execution, including care management and member engagement strategies
- Monitor performance metrics (e.g., STAR ratings, quality, operational KPIs) and report to leadership
- Identify and implement process improvements to enhance integration and member outcomes
- Develop and implement comprehensive sales strategies to drive growth and member retention
- Achieve and exceed enrollment targets
- Analyze market trends, competitor activity, and regulatory changes to inform strategy
- Identify and expand opportunities in key service areas
- Build and execute local market growth plans
- Optimize marketing channel mix including brokers, agents, telesales, and community development, and various marketing methodologies
- Recruit, train, and coach new hires on product, regulatory (State and Federal), and compliance requirements
- Educate and develop internal sales representatives
- Ensure full and accurate communication of benefits and disclosure of restrictions are presented to each prospect, including provider and medication confirmations
- Document oversight on all areas of the sales and retention process
- Set performance expectations and monitor results
- Ensure all sales activities adhere to CMS Marketing and Communication Guidelines
- Maintain accurate documentation and reporting standards
- Oversee Medicare sales call center operations, including inbound and outbound activity
- Ensure call center performance meets KPIs such as call quality, compliance scores, and service levels
- Partner with operations teams to optimize staffing models, scripting, training, and technology platforms
- Drive continuous improvement in customer experience and sales effectiveness within the call center environment
- Ensure successful CMS Call Center Monitoring Audit
- Provide oversight of sales administration functions including reporting, forecasting, enrollment processing, and documentation
- Ensure accurate tracking of sales metrics, commissions, and performance reporting
- Establish and maintain standardized processes for sales operations and compliance documentation
- Partner with internal teams to improve workflows, reduce errors, and enhance operational efficiency
Skills
- Active health insurance license and AHIP certification REQUIRED
- 5+ years of experience in Medicare Advantage, Medicaid, or managed care operations
- Extensive knowledge of Medicare Advantage, AHCCCS, CMS regulations and D-SNP requirements
- Strong cross-functional leadership and regulatory/compliance experience
- Proven leadership experience managing sales team, call center, and community outreach
- Demonstrated success achieving aggressive sales and retention targets
- Data analysis and performance management capability
- Ability to effectively communicate with executive level management
- Experience with D-SNP or dual-eligible populations
- Familiarity with AHCCCS, LTSS, or integrated care models
- Experience supporting CMS audits or NCQA accreditation
Benefits
- 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.
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