Senior Manager, Medicaid Compliance
CVS Health
full-time
Posted on:
Location Type: Hybrid
Location: New Albany • Ohio • United States
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Salary
💰 $75,400 - $165,954 per year
Job Level
About the role
- 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
regulatory complianceproject managementauditMedicaidmanaged carehealth careinsurancereport preparationrisk assessmentpolicy development
Soft Skills
communicationrelationship managementleadershiptrainingguidancestrategic thinkingproblem-solvingindependencecollaborationoversight
Certifications
Bachelor’s DegreeMaster’s DegreeJuris Doctor