Über diese Senior Manager, Medicaid Compliance - Ohio Stelle bei CVS Health
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Position Summary:
As a Senior Manager of Medicaid Compliance, you are responsible for the management, execution, and oversight of the compliance program activities and deliverables of a Medicaid managed care organization operating in a moderately complex regulatory environment. This role will allow you to serve as the designated Compliance Officer for Aetna’s Ohio (OH) Medicaid health plan. You will oversee the activities of other compliance team members assigned to the Ohio market. You will be responsible for developing and maintaining systems and processes that demonstrate the principles of an effective Compliance program and promote compliant and ethical behavior in the assigned Medicaid health plan.
Responsibilities include, but are not limited to:
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 and responses to state Medicaid agencies on or before required due dates; independently prepares and oversees the submission of complex regulatory reports and deliverables as needed on behalf of the Medicaid compliance team
Facilitates the preparation for and management of external audits conducted by state Medicaid and related agencies or partners in conjunction with health plan leadership through final report and corrective action plan closure
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 in accordance with state specific Medicaid program requirements
Develop compelling, strategic, and appropriate compliance related communications on behalf of the health plan in response to state Medicaid agency inquiries or requests
Maintain an in-depth working knowledge of the health plan’s contractual, regulatory, and program policy related obligations as a Medicaid managed care organization and serve as a resource to health plan and growth partner staff for education, training, and business decision making purposes
Ensure that current resource tools and other internal deliverables such as current contract library, regulatory reporting assignments, risk assessments, risk tracking lists, internal reporting systems and summaries, and other department wide tools are current and accessible to business partners to ensure the appropriate monitoring and oversight of health plan compliance processes
Identify key areas of risk or concern and proactively conduct oversight and monitoring to evaluate levels of compliance with Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns and other issues through appropriate channels
Utilize systems unique to job functions, including standard-issue software such as Microsoft products and compliance specific tools such as Archer; maintain system documentation, serve as subject matter expert, train users of system, contribute to system design, oversight or maintenance
Lead and direct oversight and monitoring activities to evaluate levels of compliance with new and existing Medicaid managed care organization requirements across the business; support business partners in the development of mitigation and corrective action plans and effectively escalate risks, concerns, and other issues through appropriate channels
Maintain positive, productive relationships with internal and external senior level constituents to effectively communicate and influence ethical and compliant outcomes
Provide training and guidance to less experienced team members to accomplish goals
Other duties as assigned
Required Qualifications:
7+ years of regulatory compliance experience in managed care, health care, or insurance.
2+ years of project management experience.
Preferred Qualifications:
Experience with Medicaid or Medicaid managed care.
Audit experience.
Master’s degree or Juris Doctor.
Education:
Bachelor’s Degree preferably in Public Policy, Government Affairs, Health Care Administration, or Public Administration; required or equivalent years of related professional work experience.
Pay Range
The typical pay range for this role is:
$75,400.00 - $165,954.00
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
