Easter Seals Jobs

OVERVIEW

The Senior Manager of Medicare Advantage Provider Directory Vendor and Regulatory Operations is responsible for overseeing the regulatory compliance (e.g., state and federal) of the provider directory, network adequacy, and all related processes, as well as providing vendor and business operations support for the overall Provider Directory Management team.

KEY RESPONSIBILITIES:

Regulatory Compliance and Oversight:

• Ensure the provider directory and all related processes comply with all regulations, including but not limited to state requirements, CMS (Centers for Medicare & Medicaid Services) requirements, and NCQA (National Committee for Quality Assurance) requirements

• Lead the preparation and submission of all regulatory reports related to the provider directory and network adequacy, including reports required by CMS and other relevant regulatory bodies

• Serve as the subject matter expert on all regulations relevant to the Medicare provider directory and network adequacy, providing guidance to internal teams on compliance-related matters.

• Work with internal compliance and legal teams to ensure ongoing adherence to regulatory requirements.

Vendor and Business Operations Support:

• Oversee performance of all third-party vendors that support provider directory operations to ensure timely delivery of services and compliance with contractual obligations.

• Establish clear performance expectations, metrics, and service-level agreements (SLAs) with vendors, and regularly review vendor performance against these benchmarks.

• Support procurement and legal teams as needed to negotiate contracts, renewals, and agreements with vendors in line with organizational goals and compliance needs.

Reporting and Analytics:

• Develop and oversee the reporting framework to track key metrics related to regulatory compliance and vendor/business operations.

• Generate and present regular reports to senior leadership, identifying trends, challenges, and areas for improvement.

• Use data insights to recommend changes and improvements to directory operations, ensuring efficiency and compliance with all regulations.

Process Improvement and Cross-functional Collaboration:

• Identify opportunities for process improvements and innovations in directory and network adequacy management to meet evolving regulations and improve the member experience.

• Stay informed of industry trends and best practices related to provider directory and network adequacy management, vendor relationships, and CMS compliance.

• Partner with network operations, provider relations, IT, and compliance teams to ensure directory processes are integrated across the organization and aligned with broader strategic goals.

• Work closely with legal and procurement teams to manage contracts and compliance obligations with external vendors.

Team Leadership and Development:

• Lead, coach, and develop a team of compliance and vendor/business operations professionals, fostering a culture of collaboration, accountability, and continuous improvement.

• Foster a collaborative environment, encouraging continuous learning and knowledge-sharing within the team.

• Set performance goals for the team and monitor progress against key compliance and operational metrics.

• Provide ongoing training and support to ensure staff are knowledgeable about industry best practices and CMS requirements.

QUALIFICATIONS

• Bachelor’s degree in healthcare administration, business, regulatory affairs, or a related field strongly preferred. A Master’s degree is preferred.

• 5+ years of experience in provider directory operations, regulatory compliance, and/or vendor management. Experience with Medicare Advantage is preferred.

• In-depth knowledge of CMS guidelines and other regulatory requirements for Medicare Advantage provider directories.

• Experience managing third-party vendor relationships, including performance management and administrative/operational support.

• Experience in leading teams and managing complex cross-functional projects in a healthcare environment.

• Strong understanding of CMS regulations and compliance requirements for Medicare Advantage provider directories and network adequacy.

• Excellent vendor management skills, with experience in overseeing vendor performance.

• Strong leadership skills, with experience managing teams in a dynamic, fast-paced environment.

• Excellent communication and collaboration skills, with the ability to work with both technical and non-technical stakeholders.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an annual salary of 107,800 - 179,600 USD / yearly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.