Hybrid Senior Manager, Medicaid Compliance

at CVS Health

• Job title: Senior Manager, Medicaid Compliance
• Job type: Full Time
• Experience level: Senior
• Salary: $75,400 - $165,954 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, New Albany, United States

About the role

• Senior Manager overseeing Medicaid compliance for Aetna's Ohio Medicaid health plan, managing compliance program activities and liaising with state Medicaid agencies.

Responsibilities

• Responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization
• Acts as the primary liaison to the state Medicaid agency, facilitating compliance and contract-related communications and activities
• Maintain the systems and tools to track, monitor, review, and submit required regulatory and compliance related deliverables
• Independently prepares and oversees the submission of complex regulatory reports and deliverables as needed
• Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners
• Lead and execute all elements of the Medicaid compliance program for Aetna’s OH Medicaid health plan
• Conduct research and develop recommendations to help develop compliant business operations, processes, and policies
• Develop compelling, strategic, and appropriate compliance related communications
• Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations
• Identify key areas of risk or concern and conduct oversight and monitoring to evaluate levels of compliance; support business partners in the development of mitigation and corrective action plans
• Maintain positive, productive relationships with internal and external senior level constituents
• Provide training and guidance to less experienced team members

Requirements

• Minimum of 7 years regulatory compliance experience in managed care, health care, or insurance
• Minimum of 1 year project management experience
• Experience with Medicaid or Medicaid managed care
• Audit experience
• Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; equivalent years of related professional work experience may substitute
• Master’s degree or Juris Doctor preferred.

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs
• Confidential counseling and financial coaching
• Paid time off
• Flexible work schedules
• Family leave
• Dependent care resources
• Colleague assistance programs
• Tuition assistance
• Retiree medical access and many other benefits depending on eligibility.